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Min YG, Moon Y, Kwon YN, Lee BJ, Park KA, Han JY, Han J, Lee HJ, Baek SH, Kim BJ, Kim JS, Park KS, Kim NH, Kim M, Nam TS, Oh SI, Jung JH, Sung JJ, Jang MJ, Kim SJ, Kim SM. Prognostic factors of first-onset optic neuritis based on diagnostic criteria and antibody status: a multicentre analysis of 427 eyes. J Neurol Neurosurg Psychiatry 2024; 95:753-760. [PMID: 38418215 DOI: 10.1136/jnnp-2023-333133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/22/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Optic neuritis (ON) prognosis is influenced by various factors including attack severity, underlying aetiologies, treatments and consequences of previous episodes. This study, conducted on a large cohort of first ON episodes, aimed to identify unique prognostic factors for each ON subtype, while excluding any potential influence from pre-existing sequelae. METHODS Patients experiencing their first ON episodes, with complete aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) antibody testing, and clinical data for applying multiple sclerosis (MS) diagnostic criteria, were enrolled. 427 eyes from 355 patients from 10 hospitals were categorised into four subgroups: neuromyelitis optica with AQP4 IgG (NMOSD-ON), MOG antibody-associated disease (MOGAD-ON), ON in MS (MS-ON) or idiopathic ON (ION). Prognostic factors linked to complete recovery (regaining 20/20 visual acuity (VA)) or moderate recovery (regaining 20/40 VA) were assessed through multivariable Cox regression analysis. RESULTS VA at nadir emerged as a robust prognostic factor for both complete and moderate recovery, spanning all ON subtypes. Early intravenous methylprednisolone (IVMP) was associated with enhanced complete recovery in NMOSD-ON and MOGAD-ON, but not in MS-ON or ION. Interestingly, in NMOSD-ON, even a slight IVMP delay in IVMP by >3 days had a significant negative impact, whereas a moderate delay up to 7-9 days was permissible in MOGAD-ON. Female sex predicted poor recovery in MOGAD-ON, while older age hindered moderate recovery in NMOSD-ON and ION. CONCLUSION This comprehensive multicentre analysis on first-onset ON unveils subtype-specific prognostic factors. These insights will assist tailored treatment strategies and patient counselling for ON.
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Affiliation(s)
- Young Gi Min
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Yeji Moon
- Department of Ophthalmology, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Young Nam Kwon
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Byung Joo Lee
- Department of Ophthalmology, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Seoul, Korea (the Republic of)
| | - Jae Yong Han
- Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Jinu Han
- Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Haeng-Jin Lee
- Department of Ophthalmology, Jeonbuk National University Hospital, Jeonju, Korea (the Republic of)
| | - Seol-Hee Baek
- Department of Neurology, Korea University Anam Hospital, Seoul, Korea (the Republic of)
| | - Byung-Jo Kim
- Department of Neurology, Korea University Anam Hospital, Seoul, Korea (the Republic of)
| | - Jun-Soon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
| | - Kyung Seok Park
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
| | - Nam-Hee Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Ilsan, Korea (the Republic of)
| | - Martha Kim
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Ilsan, Korea (the Republic of)
| | - Tai-Seung Nam
- Department of Neurology, Chonnam University Hospital, Hwasun, Korea (the Republic of)
| | - Seong-Il Oh
- Department of Neurology, Kyung Hee University Hospital, Seoul, Korea (the Republic of)
- Department of Neurology, Busan Paik Hospital, Busan, Korea (the Republic of)
| | - Jae Ho Jung
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Jung-Joon Sung
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Myoung-Jin Jang
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Seong-Joon Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Sung-Min Kim
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (the Republic of)
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Jarocki A, Benard-Seguin E, Gonzalez LA, Costello F, Andrews CA, Kerber K, De Lott LB. Predictors of Long-Term Visual Acuity in a Modern Cohort of Patients With Acute Idiopathic and Multiple Sclerosis-Associated Optic Neuritis. J Neuroophthalmol 2023; 43:475-480. [PMID: 37200095 PMCID: PMC10656360 DOI: 10.1097/wno.0000000000001870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
BACKGROUND For patients with idiopathic or multiple sclerosis (MS)-associated optic neuritis (ON), the largest multicenter clinical trial (Optic Neuritis Treatment Trial [ONTT]) showed excellent visual outcomes and baseline high-contrast visual acuity (HCVA) was the only predictor of HCVA at 1 year. We aimed to evaluate predictors of long-term HCVA in a modern, real-world population of patients with ON and compare with previously published ONTT models. METHODS We performed a retrospective, longitudinal, observational study at the University of Michigan and the University of Calgary evaluating 135 episodes of idiopathic or MS-associated ON in 118 patients diagnosed by a neuro-ophthalmologist within 30 days of onset (January 2011-June 2021). Primary outcome measured was HCVA (Snellen equivalents) at 6-18 months. Multiple linear regression models of 107 episodes from 93 patients assessed the association between HCVA at 6-18 months and age, sex, race, pain, optic disc swelling, symptoms (days), viral illness prodrome, MS status, high-dose glucocorticoid treatment, and baseline HCVA. RESULTS Of the 135 acute episodes (109 Michigan and 26 Calgary), median age at presentation was 39 years (interquartile range [IQR], 31-49 years), 91 (67.4%) were women, 112 (83.0%) were non-Hispanic Caucasians, 101 (75.9%) had pain, 33 (24.4%) had disc edema, 8 (5.9%) had a viral prodrome, 66 (48.9%) had MS, and 62 (46.6%) were treated with glucocorticoids. The median (IQR) time between symptom onset and diagnosis was 6 days (range, 4-11 days). The median (IQR) HCVA at baseline and at 6-18 months were 20/50 (20/22, 20/200) and 20/20 (20/20, 20/27), respectively; 62 (45.9%) had better than 20/40 at baseline and 117 (86.7%) had better than 20/40 at 6-18 months. In linear regression models (n = 107 episodes in 93 patients with baseline HCVA better than CF), only baseline HCVA (β = 0.076; P = 0.027) was associated with long-term HCVA. Regression coefficients were similar and within the 95% confidence interval of coefficients from published ONTT models. CONCLUSIONS In a modern cohort of patients with idiopathic or MS-associated ON with baseline HCVA better than CF, long-term outcomes were good, and the only predictor was baseline HCVA. These findings were similar to prior analyses of ONTT data, and as a result, these are validated for use in conveying prognostic information about long-term HCVA outcomes.
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Affiliation(s)
- Adrienne Jarocki
- University of Michigan Medical School (AJ), Ann Arbor, Michigan; Department of Surgery (EB-S, FC) and Clinical Neurosciences (FC), University of Calgary, Calgary, Canada ; Department of Ophthalmology and Visual Sciences (LAG, CAA, LBDL) and Neurology (LBDL), University of Michigan, Ann Arbor, Michigan; Department of Neurology (KK), Ohio State University, Columbus, Ohio
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Nathoo N, Zeydan B, Neyal N, Chelf C, Okuda DT, Kantarci OH. Do magnetic resonance imaging features differ between persons with multiple sclerosis of various races and ethnicities? Front Neurol 2023; 14:1215774. [PMID: 37448745 PMCID: PMC10338060 DOI: 10.3389/fneur.2023.1215774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Those of African American or Latin American descent have been demonstrated to have more severe clinical presentations of multiple sclerosis (MS) than non-Latin American White people with MS. Concurrently, radiological burden of disease on magnetic resonance imaging (MRI) in African Americans with MS has also been described as being more aggressive. Here, we review MRI studies in diverse racial and ethnic groups (adult and pediatric) investigating lesion burden, inflammation, neurodegeneration, and imaging response to disease modifying therapy. We also discuss why such disparities may exist beyond biology, and how future studies may provide greater insights into underlying differences.
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Affiliation(s)
- Nabeela Nathoo
- Division of Multiple Sclerosis and Autoimmune Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Burcu Zeydan
- Division of Multiple Sclerosis and Autoimmune Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Nur Neyal
- Division of Multiple Sclerosis and Autoimmune Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Cynthia Chelf
- Mayo Clinic College of Medicine and Science, Library-Public Services, Mayo Clinic, Rochester, MN, United States
| | - Darin T. Okuda
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Orhun H. Kantarci
- Division of Multiple Sclerosis and Autoimmune Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, United States
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Hurtubise B, Frohman EM, Galetta S, Balcer LJ, Frohman TC, Lisak RP, Newsome SD, Graves JS, Zamvil SS, Amezcua L. MOG Antibody-Associated Disease and Thymic Hyperplasia: From the National Multiple Sclerosis Society Case Conference Proceedings. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:e200077. [PMID: 36517233 PMCID: PMC9753285 DOI: 10.1212/nxi.0000000000200077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/26/2022] [Indexed: 12/15/2022]
Abstract
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently described CNS inflammatory disorder that may manifest with optic neuritis, myelitis, seizures, and/or acute disseminated encephalomyelitis. While MOG-specific antibodies in patients with MOGAD are IgG1, a T-cell-dependent antibody isotype, immunologic mechanisms of this disease are not fully understood. Thymic hyperplasia can be associated with certain autoimmune diseases. In this report we describe a case of MOGAD associated with thymic hyperplasia in a young adult.
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Affiliation(s)
- Brigitte Hurtubise
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Elliot M Frohman
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Steven Galetta
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Laura J Balcer
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Teresa C Frohman
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Robert P Lisak
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Scott D Newsome
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Jennifer S Graves
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Scott S Zamvil
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco.
| | - Lilyana Amezcua
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
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Murgia F, Giagnoni F, Lorefice L, Caria P, Dettori T, D’Alterio MN, Angioni S, Hendren AJ, Caboni P, Pibiri M, Monni G, Cocco E, Atzori L. Sex Hormones as Key Modulators of the Immune Response in Multiple Sclerosis: A Review. Biomedicines 2022; 10:biomedicines10123107. [PMID: 36551863 PMCID: PMC9775368 DOI: 10.3390/biomedicines10123107] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND A variety of autoimmune diseases, including MS, amplify sex-based physiological differences in immunological responsiveness. Female MS patients experience pathophysiological changes during reproductive phases (pregnancy and menopause). Sex hormones can act on immune cells, potentially enabling them to modify MS risk, activity, and progression, and to play a role in treatment. METHODS Scientific papers (published between 1998 and 2021) were selected through PubMed, Google Scholar, and Web of Science literature repositories. The search was limited to publications analyzing the hormonal profile of male and female MS patients during different life phases, in particular focusing on sex hormone treatment. RESULTS Both men and women with MS have lower testosterone levels compared to healthy controls. The levels of estrogens and progesterone increase during pregnancy and then rapidly decrease after delivery, possibly mediating an immune-stabilizing process. The literature examined herein evidences the neuroprotective effect of testosterone and estrogens in MS, supporting further examinations of their potential therapeutic uses. CONCLUSIONS A correlation has been identified between sex hormones and MS clinical activity. The combination of disease-modifying therapies with estrogen or estrogen plus a progestin receptor modulator promoting myelin repair might represent an important strategy for MS treatment in the future.
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Affiliation(s)
- Federica Murgia
- Clinical Metabolomics Unit, Department of Biomedical Sciences, University of Cagliari, 09124 Cagliari, Italy
- Correspondence:
| | - Florianna Giagnoni
- Clinical Metabolomics Unit, Department of Biomedical Sciences, University of Cagliari, 09124 Cagliari, Italy
| | - Lorena Lorefice
- Multiple Sclerosis Regional Center, ASSL Cagliari, ATS Sardinia, 09126 Cagliari, Italy
| | - Paola Caria
- Department of Biomedical Sciences, Section of Biochemistry, Biology, and Genetics, University of Cagliari, Cittadella Universitaria, 09124 Cagliari, Italy
| | - Tinuccia Dettori
- Department of Biomedical Sciences, Section of Biochemistry, Biology, and Genetics, University of Cagliari, Cittadella Universitaria, 09124 Cagliari, Italy
| | - Maurizio N. D’Alterio
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
| | - Aran J. Hendren
- Sussex Neuroscience, University of Sussex, Brighton BN1 9QG, UK
| | - Pierluigi Caboni
- Department of Life and Environmental Sciences, University of Cagliari, 09124 Cagliari, Italy
| | - Monica Pibiri
- Department of Biomedical Sciences, University of Cagliari, 09124 Cagliari, Italy
| | - Giovanni Monni
- Department of Obstetrics and Gynecology, Prenatal and Preimplantation Genetic Diagnosis, Fetal Therapy, Microcitemico Pediatric Hospital “A. Cao”, 09121 Cagliari, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Regional Center, ASSL Cagliari, ATS Sardinia, Department of Medical Sciences and Public Health, University of Cagliari, 09126 Cagliari, Italy
| | - Luigi Atzori
- Clinical Metabolomics Unit, Department of Biomedical Sciences, University of Cagliari, 09124 Cagliari, Italy
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Liang J, Zhang Y, Liu K, Xu X, Zhao X, Qiu W, Zhang X, Yang H. Comparing evolvement of visual field defect in neuromyelitis optica spectrum disorder-optic neuritis and idiopathic optic neuritis: a prospective study. BMC Ophthalmol 2022; 22:338. [PMID: 35945524 PMCID: PMC9361552 DOI: 10.1186/s12886-022-02510-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose To compare the evolvement of visual field (VF) defect in neuromyelitis optica spectrum disorder-optic neuritis (NMOSD-ON) and idiopathic optic neuritis (IDON). Methods This prospective study involved 104 optic neuritis (ON) patients followed up for ≥ 6 months (33 patients with NMOSD-ON and 71 patients with IDON). The pattern and recovery pattern of VF defect, mean defect (MD) and pattern standard deviation (PSD) of VF, as well as BCVA at onset, 1 month (1 m), 3 months (3 m), and ≥ 6 months (6 m) after onset were compared between two groups. Analysis of these indicators in first episode patients was also done. Results Diffuse abnormalities and nerve fiber bundle abnormalities were the two most common patterns in both groups. The percentage of neurologic abnormality of VF defect in NMOSD-ON was higher than that of IDON. Compared with the IDON group, the MD and PSD of NMOSD-ON group were significantly worse at each follow-up. While a positive correlation in BCVA was found between 1 m and ≥ 6 m in the NMOSD-ON group only, a positive correlation was found between 1 m and ≥ 6 m in MD and PSD of both groups. A positive correlation was found between 3 m and ≥ 6 m in MD, PSD and BCVA of both groups. The quadrant recovery pattern was the most common pattern in both groups (57.1% in NMOSD-ON and 57.4% in IDON). The analysis of the first episode subgroup further confirmed the observation above. Conclusions The NMOSD-ON patients tended to suffer more severe VF damage, VF irregularity and worse prognosis than that of IDON patients. Diffuse abnormalities and nerve fiber bundle abnormalities were the two most common types in both groups, while neurologic abnormality more common in NMOSD-ON and central scotoma more common in IDON. The visual functions of 1 m in NMOSD-ON and 3 m in IDON were related to its prognosis.
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Affiliation(s)
- Jiaqi Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, No.54 Xianlie South Road, Guangzhou, 510060, China.,Department of Ophthalmology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510000, People's Republic of China
| | - Yuxin Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, No.54 Xianlie South Road, Guangzhou, 510060, China
| | - Kaiqun Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, No.54 Xianlie South Road, Guangzhou, 510060, China
| | - Xiaoyu Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, No.54 Xianlie South Road, Guangzhou, 510060, China
| | - Xiujuan Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, No.54 Xianlie South Road, Guangzhou, 510060, China
| | - Wei Qiu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Xinyu Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, No.54 Xianlie South Road, Guangzhou, 510060, China.
| | - Hui Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, No.54 Xianlie South Road, Guangzhou, 510060, China.
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Ysrraelit MC, Correale J. Impact of Andropause on Multiple Sclerosis. Front Neurol 2021; 12:766308. [PMID: 34803897 PMCID: PMC8602357 DOI: 10.3389/fneur.2021.766308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022] Open
Abstract
Andropause results from the natural decrease in testosterone levels that occurs with age. In contrast to menopause, which is a universal, well-characterized process associated with absolute gonadal failure, andropause ensues after gradual decline of both hypothalamic-pituitary-gonadal axis activity, as well as of testicular function, a process which usually develops over a period of many years. Increasing evidence on greater risk of Multiple sclerosis (MS) associated with lower testosterone levels is being reported. Likewise, epidemiological studies have shown a later age of onset of MS in men, relative to women, which could perhaps respond to the decline in protective testosterone levels. In this review, we will discuss the role of androgens in the development and function of the innate and adaptive immune response, as well as in neuroprotective mechanisms relevant to MS. Testosterone effects observed in different animal models and in epidemiological studies in humans will be discussed, as well as their correlation with physical disability and cognitive function levels. Finally, published and ongoing clinical trials exploring the role of androgens, particularly at key stages of sexual maturation, will be reviewed.
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Affiliation(s)
- Maria C Ysrraelit
- Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLENI), Buenos Aires, Argentina
| | - Jorge Correale
- Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLENI), Buenos Aires, Argentina
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8
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Gontkovsky ST. Understanding visual-spatial perceptual deficits in individuals with multiple sclerosis: an analysis of patient performance on the Hooper Visual Organization Test and Visual Form Discrimination. Int J Neurosci 2021; 133:636-641. [PMID: 34253124 DOI: 10.1080/00207454.2021.1954642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose: Although the cognitive sequelae of multiple sclerosis have been recognized for more than four decades, the focus of research has been on studying the more common deficits of the disease, including those involving memory and information processing speed. Less understood and investigated are the visual-spatial perceptual disturbances of multiple sclerosis, which can be difficult to assess and interpret given the potential confounds associated with the physical problems and other cognitive disturbances of the disorder.Materials and methods: This study examined the visual-spatial perceptual deficits of multiple sclerosis in 40 participants diagnosed with this condition using two measures generally unaffected by the aforementioned confounds, the Hooper Visual Organization Test and Visual Form Discrimination.Results: Results revealed both measures to be sensitive to the impairments of multiple sclerosis but suggested that they are assessing somewhat different aspects of visual-spatial perception in this population, given their relationship with one another and with disease-related variables.Conclusions: In this light, findings indicate that a complete and accurate understanding of the visual-spatial perceptual sequelae of multiple sclerosis requires the administration of more than a single measure.
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9
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Sotiropoulos MG, Lokhande H, Healy BC, Polgar-Turcsanyi M, Glanz BI, Bakshi R, Weiner HL, Chitnis T. Relapse recovery in multiple sclerosis: Effect of treatment and contribution to long-term disability. Mult Scler J Exp Transl Clin 2021; 7:20552173211015503. [PMID: 34104471 PMCID: PMC8165535 DOI: 10.1177/20552173211015503] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background Although recovery from relapses in MS appears to contribute to disability, it has largely been ignored as a treatment endpoint and disability predictor. Objective To identify demographic and clinical predictors of relapse recovery in the first 3 years and examine its contribution to 10-year disability and MRI outcomes. Methods Relapse recovery was retrospectively assessed in 360 patients with MS using the return of the Expanded Disability Status Scale (EDSS), Functional System Scale and neurologic signs to baseline at least 6 months after onset. Univariate and multivariable models were used to associate recovery with demographic and clinical factors and predict 10-year outcomes. Results Recovery from relapses in the first 3 years was better in patients who were younger, on disease-modifying treatment, with a longer disease duration and without bowel or bladder symptoms. For every incomplete recovery, 10-year EDSS increased by 0.6 and 10-year timed 25-foot walk increased by 0.5 s. These outcomes were also higher with older age and higher baseline BMI. Ten-year MRI brain atrophy was associated only with older age, and MRI lesion volume was only associated with smoking. Conclusions Early initiation of disease-modifying treatment in MS was associated with improved relapse recovery, which in turn prevented long-term disability.
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Affiliation(s)
- Marinos G Sotiropoulos
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, MA, USA
| | - Hrishikesh Lokhande
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Mariann Polgar-Turcsanyi
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Rohit Bakshi
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Howard L Weiner
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Tanuja Chitnis
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
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10
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Long-term fingolimod treatment in two pediatric patients with multiple sclerosis. Neurol Sci 2021; 42:29-36. [PMID: 33751260 DOI: 10.1007/s10072-021-05116-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/03/2021] [Indexed: 10/21/2022]
Abstract
Data suggest that patients with pediatric-onset multiple sclerosis (POMS) should initiate treatment with a disease-modifying therapy early to slow progression. The PARADIGMS trial demonstrated that oral fingolimod reduced the annual rate of relapse by 82% compared with intramuscular interferon beta-1a in children with POMS. The PARADIGMS study had a follow-up of 2 years, but no data are available about the safety and efficacy of fingolimod for longer periods in children with POMS. Here we present two cases of children with POMS who achieved sustained clinical benefit from treatment with fingolimod for more than 2 years. The first patient, an 11-year-old male, who participate in the PARADIGMS study, was treatment naïve at the time of fingolimod initiation. His clinical condition remained stable over 5 years of treatment, with no relapses and no radiological lesion progression. The second patient was a female who initiated fingolimod at the age of 12 years, 2 years after her POMS diagnosis and after an 8-month trial of interferon beta-1a. The patient had experienced two relapses during interferon beta-1a but had no relapses in more than 2 years of treatment with fingolimod, and her MRI scans showed no new or active lesions. These data show that prolonged treatment with fingolimod can be safe and effective during long-term treatment as first- or second-line therapy in children with POMS.
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11
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Chu DT, Rosso M, Gonzalez CT, Saxena S, Healy BC, Weiner HL, Chitnis T. Obesity is associated with the Optic Neuritis severity in Male patients with Multiple Sclerosis. Mult Scler Relat Disord 2021; 51:102910. [PMID: 33799288 DOI: 10.1016/j.msard.2021.102910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/27/2021] [Accepted: 03/13/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Obesity is an important modifiable risk factor of MS; a deeper biological understanding of this association is needed. OBJECTIVE To evaluate the determinants of acute optic neuritis (AON) severity and recovery in multiple sclerosis (MS). METHODS We included 61 patients with MS with recorded AON severity and recovery according to visual acuity outcomes before, at, and, after the relapse. We measured body mass index (BMI) and the serum concentration of estrogen, leptin, testosterone, sex hormone-binding globulin, and vitamin D. We tested the association between BMI and serum hormones and AON severity and recovery with logistic regressions. RESULTS In males, moderate/severe AON was associated with higher BMI (31.26 kg/m2 vs 25.73 kg/m2, logistic regression, p= 0.03), higher serum estrogen levels (32.24 nmol/L vs 23.06 nmol/L, logistic regression, p=0.04), and higher serum leptin levels (12.29 ng/mL vs mild AON: 4.1 ng/mL, logistic regression, p=0.06) than mild AON. These observations were not seen in female patients. We did not find an association with BMI or hormone levels and AON recovery. CONCLUSION BMI, serum leptin, and serum estrogen were associated with AON severity in male patients but not in female patients. No association of these factors and AON recovery was observed.
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Affiliation(s)
- Duong T Chu
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, Massachusetts, US; Harvard Medical School, Boston, Massachusetts, US
| | - Mattia Rosso
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, Massachusetts, US; Harvard Medical School, Boston, Massachusetts, US
| | - Cindy T Gonzalez
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, Massachusetts, US; Harvard Medical School, Boston, Massachusetts, US
| | - Shrishti Saxena
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, Massachusetts, US; Harvard Medical School, Boston, Massachusetts, US
| | - Brian C Healy
- Harvard Medical School, Boston, Massachusetts, US; Massachusetts General Hospital Biostatistics Center, Boston, Massachusetts, US; Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, US
| | - Howard L Weiner
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, Massachusetts, US; Harvard Medical School, Boston, Massachusetts, US; Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, US
| | - Tanuja Chitnis
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, Massachusetts, US; Harvard Medical School, Boston, Massachusetts, US; Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, US.
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12
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Chitnis T, Aaen G, Belman A, Benson L, Gorman M, Goyal MS, Graves JS, Harris Y, Krupp L, Lotze T, Mar S, Ness J, Rensel M, Schreiner T, Tillema JM, Waubant E, Weinstock-Guttman B, Roalstad S, Rose J, Weiner HL, Casper TC, Rodriguez M. Improved relapse recovery in paediatric compared to adult multiple sclerosis. Brain 2021; 143:2733-2741. [PMID: 32810215 DOI: 10.1093/brain/awaa199] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 03/01/2020] [Accepted: 04/29/2020] [Indexed: 11/14/2022] Open
Abstract
Incomplete relapse recovery contributes to disability accrual and earlier onset of secondary progressive multiple sclerosis. We sought to investigate the effect of age on relapse recovery. We identified patients with multiple sclerosis from two longitudinal prospective studies, with an Expanded Disability Status Scale (EDSS) score within 30 days after onset of an attack, and follow-up EDSS 6 months after attack. Adult patients with multiple sclerosis (n = 632) were identified from the Comprehensive Longitudinal Investigations in Multiple Sclerosis at Brigham study (CLIMB), and paediatric patients (n = 132) from the US Network of Paediatric Multiple Sclerosis Centers (NPMSC) registry. Change in EDSS was defined as the difference in EDSS between attack and follow-up. Change in EDSS at follow-up compared to baseline was significantly lower in children compared to adults (P = 0.001), as were several functional system scores. Stratification by decade at onset for change in EDSS versus age found for every 10 years of age, EDSS recovery is reduced by 0.15 points (P < 0.0001). A larger proportion of children versus adults demonstrated improvement in EDSS following an attack (P = 0.006). For every 10 years of age, odds of EDSS not improving increase by 1.33 times (P < 0.0001). Younger age is associated with improved recovery from relapses. Age-related mechanisms may provide novel therapeutic targets for disability accrual in multiple sclerosis.
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Affiliation(s)
- Tanuja Chitnis
- Partners Paediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Greg Aaen
- Paediatric Multiple Sclerosis Center, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Anita Belman
- Paediatric MS Center at NYU Langone Health, New York, NY, USA
| | - Leslie Benson
- Paediatric Multiple Sclerosis and Related Disorders Program at Boston Children's Hospital, MA, USA
| | - Mark Gorman
- Paediatric Multiple Sclerosis and Related Disorders Program at Boston Children's Hospital, MA, USA
| | | | - Jennifer S Graves
- Paediatric Multiple Sclerosis Center, University of California San Diego, San Diego, CA, USA
| | - Yolanda Harris
- UAB Center for Paediatric-Onset Demyelinating Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lauren Krupp
- Paediatric MS Center at NYU Langone Health, New York, NY, USA
| | - Timothy Lotze
- The Blue Bird Circle Clinic for Multiple Sclerosis, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Soe Mar
- Washington University, St. Louis, MO, USA
| | - Jayne Ness
- UAB Center for Paediatric-Onset Demyelinating Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mary Rensel
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | - Teri Schreiner
- Rocky Mountain Multiple Sclerosis Center, Children's Hospital Colorado, University of Colorado at Denver, Aurora, CO, USA
| | - Jan-Mendelt Tillema
- Mayo Clinic Paediatric Multiple Sclerosis Center, Mayo Clinic, Rochester, MN, USA
| | - Emmanuelle Waubant
- Paediatric Multiple Sclerosis Center, University of California San Francisco, San Francisco, CA, USA
| | - Bianca Weinstock-Guttman
- Jacobs Paediatric Multiple Sclerosis Center, State University of New York at Buffalo, Buffalo, NY, USA
| | - Shelly Roalstad
- Data Coordinating and Analysis Center, University of Utah, Salt Lake City, UT, USA
| | - John Rose
- Data Coordinating and Analysis Center, University of Utah, Salt Lake City, UT, USA
| | - Howard L Weiner
- Harvard Medical School, Boston, MA, USA.,Partners MS Center, Brigham and Women's Hospital, Boston, MA, USA
| | - T Charles Casper
- Data Coordinating and Analysis Center, University of Utah, Salt Lake City, UT, USA
| | - Moses Rodriguez
- Mayo Clinic Paediatric Multiple Sclerosis Center, Mayo Clinic, Rochester, MN, USA
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13
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Immovilli P, Rota E, Morelli N, Guidetti D. Two-year follow-up during fingolimod treatment in a pediatric multiple sclerosis patient still active on first-line treatment. Neurol Sci 2021; 42:15-18. [PMID: 33469816 DOI: 10.1007/s10072-021-05058-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
Treatment of pediatric multiple sclerosis (MS) has been increasingly debated in the last few years due to limited knowledge of treatment strategies and therapeutic options. When MS develops at a young age, it usually has a very inflammatory disease course, with many relapses and disease activity as seen in magnetic resonance imaging (MRI). Therefore, treatment with immunomodulatory drugs may be beneficial in these patients. However, limited data are available to date on the treatment of pediatric MS. Although observational, prospective, and retrospective studies provide some information on its treatment course, only one clinical trial in pediatric patients has been published, the PARADIGMS trial, which showed an 82% reduction in relapse rate with fingolimod (0.5 mg/day) versus interferon β-1a (30 μg once weekly intramuscularly). Here, we present the case of a pediatric patient with MS (age of onset, 13 years), who was initially treated with interferon β-1a for 2 years and subsequently switched to fingolimod, owing to clinical and radiological activity despite treatment with interferon β-1a.
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Affiliation(s)
- Paolo Immovilli
- Neurology Unit, Guglielmo da Saliceto Civil Hospital, Via Giuseppe Taverna 49, 29121, Piacenza, Italy.
| | - Eugenia Rota
- Neurology Unit, San Giacomo Hospital, ASL AL, Novi Ligure, Italy
| | - Nicola Morelli
- Neurology Unit, Guglielmo da Saliceto Civil Hospital, Via Giuseppe Taverna 49, 29121, Piacenza, Italy
| | - Donata Guidetti
- Neurology Unit, Guglielmo da Saliceto Civil Hospital, Via Giuseppe Taverna 49, 29121, Piacenza, Italy
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14
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Mahayana I, Sakti D, Gani T. Automated grating contrast-sensitivity: The easy test for hidden visual loss in recovered optic neuritis patient. Taiwan J Ophthalmol 2021; 12:301-304. [PMID: 36248078 PMCID: PMC9558475 DOI: 10.4103/tjo.tjo_21_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/12/2021] [Indexed: 11/05/2022] Open
Abstract
PURPOSE: Residual visual loss is an important predictor of optic neuritis relapse and progression. This study aimed to investigate the hidden residual visual loss in patients with optic neuritis using automated contrast-sensitivity (CS) function testing. MATERIALS AND METHODS: This cross-sectional study investigated 29 recovered optic neuritis patients (age: 27.69 ± 13.32 years, range: 13–51). Twenty age-matched controls with normal visual acuity (VA, in LogMAR) were recruited, for comparison with patients' VA and CS function after stable recovery from optic neuritis (6 months of follow-up). CS tests used a novel software that displays a single set of Gabor patches (2 cycles per degree at 10° ×10° of visual angle) with contrasts grating from 100% to 0.1%. RESULTS: There were 13 adolescent patients (63.6%: retrobulbar neuritis [RN]; 36.4%: papillitis), 14 adult patients (50%: RN; 42.9%: papillitis), and only 2 older patients (all with neuroretinitis). There was improvement of VA in the patient group at first diagnosis and follow-up (VA initial vs. final: 1.438 ± 1.134 vs. 0.235 ± 0.272, P < 0.001). This VA improvement was similar to control group (P = 0.052). In CS, there were significant differences in patient versus control groups (69.069% ± 70.235% vs. 27.215% ± 25.27%, P = 0.025). Linear regression showed that initial VA and CS function could not predict final VA (P = 0.183 and P = 0.138, respectively). CONCLUSIONS: Patients with optic neuritis showed decreased CS compared to control group which indicated the residual visual loss. Automated CS testing is useful in detecting residual visual loss in patients who recovered from optic neuritis.
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15
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Abstract
Retinal ganglion cell axons forming the optic nerve (ON) emerge unmyelinated from the eye and become myelinated after passage through the optic nerve lamina region (ONLR), a transitional area containing a vascular plexus. The ONLR has a number of unusual characteristics: it inhibits intraocular myelination, enables postnatal ON myelination of growing axons, modulates the fluid pressure differences between eye and brain, and is the primary lesion site in the age-related disease open angle glaucoma (OAG). We demonstrate that the human and rodent ONLR possesses a mitotically active, age-depletable neural progenitor cell (NPC) niche, with unique characteristics and culture requirements. These NPCs generate both forms of macroglia: astrocytes and oligodendrocytes, and can form neurospheres in culture. Using reporter mice with SOX2-driven, inducible gene expression, we show that ONLR-NPCs generate macroglial cells for the anterior ON. Early ONLR-NPC loss results in regional dysfunction and hypomyelination. In adulthood, ONLR-NPCs may enable glial replacement and remyelination. ONLR-NPC depletion may help explain why ON diseases such as OAG progress in severity during aging.
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16
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Abbatemarco JR, Fox RJ, Li H, Bermel RA, Ontaneda D. Vitamin D Levels and Visual System Measurements in Progressive Multiple Sclerosis: A Cross-sectional Study. Int J MS Care 2020; 23:53-58. [PMID: 33880080 DOI: 10.7224/1537-2073.2020-005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Vitamin D deficiency is associated with increased disease activity in multiple sclerosis (MS), but its role in progressive MS has not been elucidated. The objective was to determine the correlation between vitamin D levels and visual parameters in primary progressive MS (PPMS) and secondary progressive MS (SPMS). Methods Serum 25-hydroxyvitamin D (25[OH]D) and 25-hydroxyvitamin D3 (25[OH]D3) levels were obtained from the Secondary and Primary Progressive Ibudilast NeuroNEXT Trial in MS (SPRINT-MS). Visual function measurements and vitamin D associations were determined using the Pearson correlation and the generalized linear mixed model. Results The analysis included 258 patients (mean ± SD age of 55.6 ± 7.3 years, 52.7% female, and 52.3% PPMS). Mean vitamin D values were above sufficiency and were similar between PPMS and SPMS (P = .47 and P = .31). There was no association between 25(OH)D3 levels and any visual markers, including peripapillary retinal nerve fiber layer thickness (Spearman r = -0.08), macular volume (r = -0.03), ganglion cell-inner plexiform layer (r = -0.07), and 2.5% low-contrast visual acuity test (r = -0.10). No statistically significant associations between vitamin D levels and visual system measurements were detected in the PPMS and SPMS subgroups. Conclusions Vitamin D levels were not associated with optical coherence tomography findings or low-contrast letter acuity in this group of patients with progressive MS.
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Abstract
Multiple sclerosis (MS) affects approximately 1 million persons in the United States, and is the leading cause of neurological disability in young adults. The concept of precision medicine is now being applied to MS and has the promise of improved care. MS patients experience a variety of neurological symptoms, and disease severity ranges from mild to severe, and the biological underpinnings of these phenotypes are now starting to be elucidated. Precision medicine involves the classification of disease subtypes based on the underlying biology, rather than clinical phenotypes alone, and may govern disease course and treatment response. Over 18 disease-modifying drugs have been approved for the treatment of MS, and several biomarkers of treatment response are emerging. This article provides an overview of the concepts of precision medicine and emerging biological markers and their evolving role in decision-making in MS management.
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Affiliation(s)
- Tanuja Chitnis
- Tanuja Chitnis Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA/Harvard Medical School, Boston, MA, USA/Ann Romney Center for Neurologic Diseases, Brigham and Women’s Hospital, Boston, MA, USA
| | - Alexandre Prat
- Alexandre Prat Department of Neurology, Université de Montréal, Montréal, QC, Canada
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Abstract
There is significant animal model data demonstrating a benefit of testosterone on both inflammatory and neuroprotective mechanisms relevant to multiple sclerosis (MS). Several studies have demonstrated lowered testosterone levels in up to 40% of men with MS. Lower testosterone levels were correlated with worsened scores of physical and cognitive disability. There is increasing data suggesting a role of testosterone in MS risk. A pilot study has demonstrated significant benefits of testosterone replacement therapy on cognitive, radiological, and immunological outcome measures in men with MS. Larger studies in other conditions have demonstrated concerns in terms of cardiovascular risk, which indicate the need for careful monitoring upon administration to MS patients. Further studies are needed to develop safer testosterone preparations, which preserve its multiple beneficial effects, as well as multicenter clinical trials to evaluate safety, dosing, and efficacy in larger populations of men with MS. Additionally, studies are needed to further explore the role of androgens as a risk factor for MS, particularly at key life transitions.
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Affiliation(s)
- Tanuja Chitnis
- Department of Neurology, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
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20
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Cerqueira Pinto SC, Ferreira Vasconcelos CC, Aurenção JCK, Alvarenga MP, das Graças Gomes Camargo SM, Santos Thuler LC, Alvarenga RP. Pediatric Multiple Sclerosis in Rio de Janeiro: Secondary Progression and Disability. Pediatr Neurol 2019; 94:48-54. [PMID: 30850228 DOI: 10.1016/j.pediatrneurol.2018.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 12/21/2018] [Accepted: 12/23/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The onset of multiple sclerosis (MS) in 2% to 10% of cases occurs prior to 18 years of age. Early age onset appears to affect some aspects of multiple sclerosis. The objective of our study was to evaluate the prevalence, the clinical and demographic characteristics, and the disease progression in a sample of pediatric multiple sclerosis patients from a mixed population. METHODS In a cross-sectional design, the prevalence, demographic characteristics, and initial clinical forms were compared between 75 cases of pediatric multiple sclerosis (PMS) and 689 adults with MS. Sixty-five PMS patients with complete data and 260 randomly selected adults with relapsing-remitting multiple sclerosis were compared. A Kaplan-Meier analysis was conducted to compare the age at and time to Expanded Disability Status Scale (EDSS) 3, EDSS 6, and secondary progressive multiple sclerosis (SPMS). RESULTS A total of 9.8% of all MS cases with available data were PMS. All cases of PMS consisted of relapsing-remitting multiple sclerosis. Brazilians of African descent comprised 34.6% of the sample, and the female-to-male ratio was 2.4:1. At the first attack, motor alterations were more common. Benign forms were more common in PMS (84.6% versus 62.2%). Fewer PMS patients reached EDSS 6 (11.6% versus 25.4%) (P = 0.0017) and SPMS (11.1% versus 28.1%) (P = 0.005). PMS patients took longer to reach EDSS 3 (P = 0.017), EDSS 6 (P = 0.001), and SPMS (P < 0.001); however, they reached EDSS 3 earlier (P < 0.001). CONCLUSIONS In this mixed cohort, the prevalence of PMS was similar to that reported in other studies, and the pediatric patients had a more benign course than adults with MS.
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21
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Eyre M, Hameed A, Wright S, Brownlee W, Ciccarelli O, Bowman R, Lim M, Wassmer E, Thompson D, Hemingway C, Hacohen Y. Retinal nerve fibre layer thinning is associated with worse visual outcome after optic neuritis in children with a relapsing demyelinating syndrome. Dev Med Child Neurol 2018; 60:1244-1250. [PMID: 29637998 DOI: 10.1111/dmcn.13757] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2018] [Indexed: 12/26/2022]
Abstract
AIM Optic neuritis may be monophasic or occur as part of a relapsing demyelinating syndrome (RDS), such as multiple sclerosis, aquaporin-4 antibody (AQP4-Ab) neuromyelitis optical spectrum disorder (NMOSD), or myelin oligodendrocyte glycoprotein antibody (MOG-Ab)-associated disease. The aims of this study were to test whether clinical, electrophysiological, and microstructural parameters differ in multiple-sclerosis-associated optic neuritis (MS-ON) and antibody-associated optic neuritis (Ab-ON); to identify the clinical and paraclinical characteristics of children suffering worse long-term visual outcome of RDS-optic neuritis; and to explore the relationship between RNFL thickness and clinical parameters in RDS-optic neuritis. METHOD Forty-two children with optic neuritis were retrospectively studied: 22 with multiple sclerosis (MS-ON) and 20 with antibody-associated demyelination (Ab-ON: MOG-Ab=16 and AQP4-Ab=4). Clinical and paraclinical features were analysed. RESULTS Complete recovery of visual acuity was reported in 25 out of 42 children; eight out of 38 (21%) suffered moderate or severe visual impairment (logarithm of the minimum angle of resolution [logMAR]>0.5) in their worse eye, including four out of 38 who were blind (logMAR>1.3) in their worse eye (two with multiple sclerosis, two with AQP4-Ab NMOSD). None of the children with MOG-Ab were blind. Recurrence of optic neuritis was more common in the Ab-ON group than the MS-ON group (15 out of 20 vs seven out of 22, p=0.007). Retinal nerve fibre layer (RNFL) thickness at baseline inversely correlated with visual acuity at final follow-up (r=-0.41, p=0.008). There was no significant relationship between the number of episodes of optic neuritis and mean RNFL (r=-0.08, p=0.628), nor any significant relationship between the number of episodes of optic neuritis and visual impairment (r=0.03, p=0.794). INTERPRETATION In children with RDS, long-term visual impairment inversely correlated with RNFL thickness, but not with the number of relapses of optic neuritis. Optical coherence tomography may have a role in assessing children with optic neuritis to monitor disease activity and inform treatment decisions. WHAT THIS PAPER ADDS Long-term visual impairment is reported in 40% of children with a relapsing demyelinating syndrome following optic neuritis. Relapse of optic neuritis, occurring more frequently in the non-multiple-sclerosis group. Retinal nerve fibre layer thinning is associated with worse visual outcome. Optical coherence tomography can be used alongside clinical parameters as an objective measure of neuroretinal loss.
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Affiliation(s)
- Michael Eyre
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Aasim Hameed
- The Clinical and Academic Department of Ophthalmology, Department of Paediatric Ophthalmology, Great Ormond Street Hospital for Children, London, UK
| | - Sukhvir Wright
- Department of Paediatric Neurology, Birmingham Children's Hospital, Birmingham, UK
| | - Wallace Brownlee
- Department of Paediatric Neurology, Birmingham Children's Hospital, Birmingham, UK
| | - Olga Ciccarelli
- Department of Neuroinflammation, Queen Square MS Centre, UCL Institute of Neurology, London, UK.,National Institute for Health Research, UCL Hospitals, Biomedical Research Centre, London, UK
| | - Richard Bowman
- The Clinical and Academic Department of Ophthalmology, Department of Paediatric Ophthalmology, Great Ormond Street Hospital for Children, London, UK
| | - Ming Lim
- Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London, UK.,Faculty of Life Sciences and Medicine, Kings College London, London, UK
| | - Evangeline Wassmer
- Department of Paediatric Neurology, Birmingham Children's Hospital, Birmingham, UK
| | - Dorothy Thompson
- The Clinical and Academic Department of Ophthalmology, Department of Paediatric Ophthalmology, Great Ormond Street Hospital for Children, London, UK
| | - Cheryl Hemingway
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Yael Hacohen
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK.,Department of Neuroinflammation, Queen Square MS Centre, UCL Institute of Neurology, London, UK
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Chitnis T, Arnold DL, Banwell B, Brück W, Ghezzi A, Giovannoni G, Greenberg B, Krupp L, Rostásy K, Tardieu M, Waubant E, Wolinsky JS, Bar-Or A, Stites T, Chen Y, Putzki N, Merschhemke M, Gärtner J. Trial of Fingolimod versus Interferon Beta-1a in Pediatric Multiple Sclerosis. N Engl J Med 2018; 379:1017-1027. [PMID: 30207920 DOI: 10.1056/nejmoa1800149] [Citation(s) in RCA: 197] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Treatment of patients younger than 18 years of age with multiple sclerosis has not been adequately examined in randomized trials. We compared fingolimod with interferon beta-1a in this population. METHODS In this phase 3 trial, we randomly assigned patients 10 to 17 years of age with relapsing multiple sclerosis in a 1:1 ratio to receive oral fingolimod at a dose of 0.5 mg per day (0.25 mg per day for patients with a body weight of ≤40 kg) or intramuscular interferon beta-1a at a dose of 30 μg per week for up to 2 years. The primary end point was the annualized relapse rate. RESULTS Of a total of 215 patients, 107 were assigned to fingolimod and 108 to interferon beta-1a. The mean age of the patients was 15.3 years. Among all patients, there was a mean of 2.4 relapses during the preceding 2 years. The adjusted annualized relapse rate was 0.12 with fingolimod and 0.67 with interferon beta-1a (absolute difference, 0.55 relapses; relative difference, 82%; P<0.001). The key secondary end point of the annualized rate of new or newly enlarged lesions on T2-weighted magnetic resonance imaging (MRI) was 4.39 with fingolimod and 9.27 with interferon beta-1a (absolute difference, 4.88 lesions; relative difference, 53%; P<0.001). Adverse events, excluding relapses of multiple sclerosis, occurred in 88.8% of patients who received fingolimod and 95.3% of those who received interferon beta-1a. Serious adverse events occurred in 18 patients (16.8%) in the fingolimod group and included seizures (in 4 patients), infection (in 4 patients), and leukopenia (in 2 patients). Serious adverse events occurred in 7 patients (6.5%) in the interferon beta-1a group and included infection (in 2 patients) and supraventricular tachycardia (in 1 patient). CONCLUSIONS Among pediatric patients with relapsing multiple sclerosis, fingolimod was associated with a lower rate of relapse and less accumulation of lesions on MRI over a 2-year period than interferon beta-1a but was associated with a higher rate of serious adverse events. Longer studies are required to determine the durability and safety of fingolimod in pediatric multiple sclerosis. (Funded by Novartis Pharma; PARADIGMS ClinicalTrials.gov number, NCT01892722 .).
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Affiliation(s)
- Tanuja Chitnis
- From the Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston (T.C.); Montreal Neurological Institute, McGill University, and NeuroRx Research - both in Montreal (D.L.A.); Children's Hospital of Philadelphia (B.B.) and the Center for Neuroinflammation and Experimental Neurotherapeutics and the Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania - all in Philadelphia; the Department of Neuropathology (W.B.) and the Department of Pediatrics and Adolescent Medicine, German Center for Multiple Sclerosis in Childhood and Adolescence (J.G.), University Medical Center Göttingen, Göttingen, and the Division of Pediatric Neurology, Children's Hospital Datteln, Witten/Herdecke University, Datteln (K.R.) - all in Germany; Gallarate Hospital, Gallarate, Italy (A.G.); Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London (G.G.); the University of Texas Southwestern Medical Center, Children's Health, Dallas (B.G.), and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.) - both in Texas; Pediatric Multiple Sclerosis Center at NYU Langone, New York (L.K.); Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Paris (M.T.); the Department of Neurology, University of California at San Francisco, San Francisco (E.W.); Novartis Pharmaceuticals, East Hanover, NJ (T.S., Y.C., N.P.); and Novartis Pharma, Basel, Switzerland (M.M.)
| | - Douglas L Arnold
- From the Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston (T.C.); Montreal Neurological Institute, McGill University, and NeuroRx Research - both in Montreal (D.L.A.); Children's Hospital of Philadelphia (B.B.) and the Center for Neuroinflammation and Experimental Neurotherapeutics and the Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania - all in Philadelphia; the Department of Neuropathology (W.B.) and the Department of Pediatrics and Adolescent Medicine, German Center for Multiple Sclerosis in Childhood and Adolescence (J.G.), University Medical Center Göttingen, Göttingen, and the Division of Pediatric Neurology, Children's Hospital Datteln, Witten/Herdecke University, Datteln (K.R.) - all in Germany; Gallarate Hospital, Gallarate, Italy (A.G.); Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London (G.G.); the University of Texas Southwestern Medical Center, Children's Health, Dallas (B.G.), and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.) - both in Texas; Pediatric Multiple Sclerosis Center at NYU Langone, New York (L.K.); Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Paris (M.T.); the Department of Neurology, University of California at San Francisco, San Francisco (E.W.); Novartis Pharmaceuticals, East Hanover, NJ (T.S., Y.C., N.P.); and Novartis Pharma, Basel, Switzerland (M.M.)
| | - Brenda Banwell
- From the Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston (T.C.); Montreal Neurological Institute, McGill University, and NeuroRx Research - both in Montreal (D.L.A.); Children's Hospital of Philadelphia (B.B.) and the Center for Neuroinflammation and Experimental Neurotherapeutics and the Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania - all in Philadelphia; the Department of Neuropathology (W.B.) and the Department of Pediatrics and Adolescent Medicine, German Center for Multiple Sclerosis in Childhood and Adolescence (J.G.), University Medical Center Göttingen, Göttingen, and the Division of Pediatric Neurology, Children's Hospital Datteln, Witten/Herdecke University, Datteln (K.R.) - all in Germany; Gallarate Hospital, Gallarate, Italy (A.G.); Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London (G.G.); the University of Texas Southwestern Medical Center, Children's Health, Dallas (B.G.), and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.) - both in Texas; Pediatric Multiple Sclerosis Center at NYU Langone, New York (L.K.); Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Paris (M.T.); the Department of Neurology, University of California at San Francisco, San Francisco (E.W.); Novartis Pharmaceuticals, East Hanover, NJ (T.S., Y.C., N.P.); and Novartis Pharma, Basel, Switzerland (M.M.)
| | - Wolfgang Brück
- From the Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston (T.C.); Montreal Neurological Institute, McGill University, and NeuroRx Research - both in Montreal (D.L.A.); Children's Hospital of Philadelphia (B.B.) and the Center for Neuroinflammation and Experimental Neurotherapeutics and the Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania - all in Philadelphia; the Department of Neuropathology (W.B.) and the Department of Pediatrics and Adolescent Medicine, German Center for Multiple Sclerosis in Childhood and Adolescence (J.G.), University Medical Center Göttingen, Göttingen, and the Division of Pediatric Neurology, Children's Hospital Datteln, Witten/Herdecke University, Datteln (K.R.) - all in Germany; Gallarate Hospital, Gallarate, Italy (A.G.); Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London (G.G.); the University of Texas Southwestern Medical Center, Children's Health, Dallas (B.G.), and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.) - both in Texas; Pediatric Multiple Sclerosis Center at NYU Langone, New York (L.K.); Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Paris (M.T.); the Department of Neurology, University of California at San Francisco, San Francisco (E.W.); Novartis Pharmaceuticals, East Hanover, NJ (T.S., Y.C., N.P.); and Novartis Pharma, Basel, Switzerland (M.M.)
| | - Angelo Ghezzi
- From the Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston (T.C.); Montreal Neurological Institute, McGill University, and NeuroRx Research - both in Montreal (D.L.A.); Children's Hospital of Philadelphia (B.B.) and the Center for Neuroinflammation and Experimental Neurotherapeutics and the Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania - all in Philadelphia; the Department of Neuropathology (W.B.) and the Department of Pediatrics and Adolescent Medicine, German Center for Multiple Sclerosis in Childhood and Adolescence (J.G.), University Medical Center Göttingen, Göttingen, and the Division of Pediatric Neurology, Children's Hospital Datteln, Witten/Herdecke University, Datteln (K.R.) - all in Germany; Gallarate Hospital, Gallarate, Italy (A.G.); Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London (G.G.); the University of Texas Southwestern Medical Center, Children's Health, Dallas (B.G.), and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.) - both in Texas; Pediatric Multiple Sclerosis Center at NYU Langone, New York (L.K.); Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Paris (M.T.); the Department of Neurology, University of California at San Francisco, San Francisco (E.W.); Novartis Pharmaceuticals, East Hanover, NJ (T.S., Y.C., N.P.); and Novartis Pharma, Basel, Switzerland (M.M.)
| | - Gavin Giovannoni
- From the Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston (T.C.); Montreal Neurological Institute, McGill University, and NeuroRx Research - both in Montreal (D.L.A.); Children's Hospital of Philadelphia (B.B.) and the Center for Neuroinflammation and Experimental Neurotherapeutics and the Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania - all in Philadelphia; the Department of Neuropathology (W.B.) and the Department of Pediatrics and Adolescent Medicine, German Center for Multiple Sclerosis in Childhood and Adolescence (J.G.), University Medical Center Göttingen, Göttingen, and the Division of Pediatric Neurology, Children's Hospital Datteln, Witten/Herdecke University, Datteln (K.R.) - all in Germany; Gallarate Hospital, Gallarate, Italy (A.G.); Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London (G.G.); the University of Texas Southwestern Medical Center, Children's Health, Dallas (B.G.), and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.) - both in Texas; Pediatric Multiple Sclerosis Center at NYU Langone, New York (L.K.); Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Paris (M.T.); the Department of Neurology, University of California at San Francisco, San Francisco (E.W.); Novartis Pharmaceuticals, East Hanover, NJ (T.S., Y.C., N.P.); and Novartis Pharma, Basel, Switzerland (M.M.)
| | - Benjamin Greenberg
- From the Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston (T.C.); Montreal Neurological Institute, McGill University, and NeuroRx Research - both in Montreal (D.L.A.); Children's Hospital of Philadelphia (B.B.) and the Center for Neuroinflammation and Experimental Neurotherapeutics and the Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania - all in Philadelphia; the Department of Neuropathology (W.B.) and the Department of Pediatrics and Adolescent Medicine, German Center for Multiple Sclerosis in Childhood and Adolescence (J.G.), University Medical Center Göttingen, Göttingen, and the Division of Pediatric Neurology, Children's Hospital Datteln, Witten/Herdecke University, Datteln (K.R.) - all in Germany; Gallarate Hospital, Gallarate, Italy (A.G.); Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London (G.G.); the University of Texas Southwestern Medical Center, Children's Health, Dallas (B.G.), and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.) - both in Texas; Pediatric Multiple Sclerosis Center at NYU Langone, New York (L.K.); Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Paris (M.T.); the Department of Neurology, University of California at San Francisco, San Francisco (E.W.); Novartis Pharmaceuticals, East Hanover, NJ (T.S., Y.C., N.P.); and Novartis Pharma, Basel, Switzerland (M.M.)
| | - Lauren Krupp
- From the Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston (T.C.); Montreal Neurological Institute, McGill University, and NeuroRx Research - both in Montreal (D.L.A.); Children's Hospital of Philadelphia (B.B.) and the Center for Neuroinflammation and Experimental Neurotherapeutics and the Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania - all in Philadelphia; the Department of Neuropathology (W.B.) and the Department of Pediatrics and Adolescent Medicine, German Center for Multiple Sclerosis in Childhood and Adolescence (J.G.), University Medical Center Göttingen, Göttingen, and the Division of Pediatric Neurology, Children's Hospital Datteln, Witten/Herdecke University, Datteln (K.R.) - all in Germany; Gallarate Hospital, Gallarate, Italy (A.G.); Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London (G.G.); the University of Texas Southwestern Medical Center, Children's Health, Dallas (B.G.), and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.) - both in Texas; Pediatric Multiple Sclerosis Center at NYU Langone, New York (L.K.); Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Paris (M.T.); the Department of Neurology, University of California at San Francisco, San Francisco (E.W.); Novartis Pharmaceuticals, East Hanover, NJ (T.S., Y.C., N.P.); and Novartis Pharma, Basel, Switzerland (M.M.)
| | - Kevin Rostásy
- From the Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston (T.C.); Montreal Neurological Institute, McGill University, and NeuroRx Research - both in Montreal (D.L.A.); Children's Hospital of Philadelphia (B.B.) and the Center for Neuroinflammation and Experimental Neurotherapeutics and the Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania - all in Philadelphia; the Department of Neuropathology (W.B.) and the Department of Pediatrics and Adolescent Medicine, German Center for Multiple Sclerosis in Childhood and Adolescence (J.G.), University Medical Center Göttingen, Göttingen, and the Division of Pediatric Neurology, Children's Hospital Datteln, Witten/Herdecke University, Datteln (K.R.) - all in Germany; Gallarate Hospital, Gallarate, Italy (A.G.); Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London (G.G.); the University of Texas Southwestern Medical Center, Children's Health, Dallas (B.G.), and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.) - both in Texas; Pediatric Multiple Sclerosis Center at NYU Langone, New York (L.K.); Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Paris (M.T.); the Department of Neurology, University of California at San Francisco, San Francisco (E.W.); Novartis Pharmaceuticals, East Hanover, NJ (T.S., Y.C., N.P.); and Novartis Pharma, Basel, Switzerland (M.M.)
| | - Marc Tardieu
- From the Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston (T.C.); Montreal Neurological Institute, McGill University, and NeuroRx Research - both in Montreal (D.L.A.); Children's Hospital of Philadelphia (B.B.) and the Center for Neuroinflammation and Experimental Neurotherapeutics and the Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania - all in Philadelphia; the Department of Neuropathology (W.B.) and the Department of Pediatrics and Adolescent Medicine, German Center for Multiple Sclerosis in Childhood and Adolescence (J.G.), University Medical Center Göttingen, Göttingen, and the Division of Pediatric Neurology, Children's Hospital Datteln, Witten/Herdecke University, Datteln (K.R.) - all in Germany; Gallarate Hospital, Gallarate, Italy (A.G.); Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London (G.G.); the University of Texas Southwestern Medical Center, Children's Health, Dallas (B.G.), and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.) - both in Texas; Pediatric Multiple Sclerosis Center at NYU Langone, New York (L.K.); Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Paris (M.T.); the Department of Neurology, University of California at San Francisco, San Francisco (E.W.); Novartis Pharmaceuticals, East Hanover, NJ (T.S., Y.C., N.P.); and Novartis Pharma, Basel, Switzerland (M.M.)
| | - Emmanuelle Waubant
- From the Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston (T.C.); Montreal Neurological Institute, McGill University, and NeuroRx Research - both in Montreal (D.L.A.); Children's Hospital of Philadelphia (B.B.) and the Center for Neuroinflammation and Experimental Neurotherapeutics and the Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania - all in Philadelphia; the Department of Neuropathology (W.B.) and the Department of Pediatrics and Adolescent Medicine, German Center for Multiple Sclerosis in Childhood and Adolescence (J.G.), University Medical Center Göttingen, Göttingen, and the Division of Pediatric Neurology, Children's Hospital Datteln, Witten/Herdecke University, Datteln (K.R.) - all in Germany; Gallarate Hospital, Gallarate, Italy (A.G.); Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London (G.G.); the University of Texas Southwestern Medical Center, Children's Health, Dallas (B.G.), and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.) - both in Texas; Pediatric Multiple Sclerosis Center at NYU Langone, New York (L.K.); Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Paris (M.T.); the Department of Neurology, University of California at San Francisco, San Francisco (E.W.); Novartis Pharmaceuticals, East Hanover, NJ (T.S., Y.C., N.P.); and Novartis Pharma, Basel, Switzerland (M.M.)
| | - Jerry S Wolinsky
- From the Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston (T.C.); Montreal Neurological Institute, McGill University, and NeuroRx Research - both in Montreal (D.L.A.); Children's Hospital of Philadelphia (B.B.) and the Center for Neuroinflammation and Experimental Neurotherapeutics and the Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania - all in Philadelphia; the Department of Neuropathology (W.B.) and the Department of Pediatrics and Adolescent Medicine, German Center for Multiple Sclerosis in Childhood and Adolescence (J.G.), University Medical Center Göttingen, Göttingen, and the Division of Pediatric Neurology, Children's Hospital Datteln, Witten/Herdecke University, Datteln (K.R.) - all in Germany; Gallarate Hospital, Gallarate, Italy (A.G.); Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London (G.G.); the University of Texas Southwestern Medical Center, Children's Health, Dallas (B.G.), and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.) - both in Texas; Pediatric Multiple Sclerosis Center at NYU Langone, New York (L.K.); Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Paris (M.T.); the Department of Neurology, University of California at San Francisco, San Francisco (E.W.); Novartis Pharmaceuticals, East Hanover, NJ (T.S., Y.C., N.P.); and Novartis Pharma, Basel, Switzerland (M.M.)
| | - Amit Bar-Or
- From the Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston (T.C.); Montreal Neurological Institute, McGill University, and NeuroRx Research - both in Montreal (D.L.A.); Children's Hospital of Philadelphia (B.B.) and the Center for Neuroinflammation and Experimental Neurotherapeutics and the Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania - all in Philadelphia; the Department of Neuropathology (W.B.) and the Department of Pediatrics and Adolescent Medicine, German Center for Multiple Sclerosis in Childhood and Adolescence (J.G.), University Medical Center Göttingen, Göttingen, and the Division of Pediatric Neurology, Children's Hospital Datteln, Witten/Herdecke University, Datteln (K.R.) - all in Germany; Gallarate Hospital, Gallarate, Italy (A.G.); Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London (G.G.); the University of Texas Southwestern Medical Center, Children's Health, Dallas (B.G.), and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.) - both in Texas; Pediatric Multiple Sclerosis Center at NYU Langone, New York (L.K.); Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Paris (M.T.); the Department of Neurology, University of California at San Francisco, San Francisco (E.W.); Novartis Pharmaceuticals, East Hanover, NJ (T.S., Y.C., N.P.); and Novartis Pharma, Basel, Switzerland (M.M.)
| | - Tracy Stites
- From the Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston (T.C.); Montreal Neurological Institute, McGill University, and NeuroRx Research - both in Montreal (D.L.A.); Children's Hospital of Philadelphia (B.B.) and the Center for Neuroinflammation and Experimental Neurotherapeutics and the Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania - all in Philadelphia; the Department of Neuropathology (W.B.) and the Department of Pediatrics and Adolescent Medicine, German Center for Multiple Sclerosis in Childhood and Adolescence (J.G.), University Medical Center Göttingen, Göttingen, and the Division of Pediatric Neurology, Children's Hospital Datteln, Witten/Herdecke University, Datteln (K.R.) - all in Germany; Gallarate Hospital, Gallarate, Italy (A.G.); Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London (G.G.); the University of Texas Southwestern Medical Center, Children's Health, Dallas (B.G.), and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.) - both in Texas; Pediatric Multiple Sclerosis Center at NYU Langone, New York (L.K.); Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Paris (M.T.); the Department of Neurology, University of California at San Francisco, San Francisco (E.W.); Novartis Pharmaceuticals, East Hanover, NJ (T.S., Y.C., N.P.); and Novartis Pharma, Basel, Switzerland (M.M.)
| | - Yu Chen
- From the Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston (T.C.); Montreal Neurological Institute, McGill University, and NeuroRx Research - both in Montreal (D.L.A.); Children's Hospital of Philadelphia (B.B.) and the Center for Neuroinflammation and Experimental Neurotherapeutics and the Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania - all in Philadelphia; the Department of Neuropathology (W.B.) and the Department of Pediatrics and Adolescent Medicine, German Center for Multiple Sclerosis in Childhood and Adolescence (J.G.), University Medical Center Göttingen, Göttingen, and the Division of Pediatric Neurology, Children's Hospital Datteln, Witten/Herdecke University, Datteln (K.R.) - all in Germany; Gallarate Hospital, Gallarate, Italy (A.G.); Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London (G.G.); the University of Texas Southwestern Medical Center, Children's Health, Dallas (B.G.), and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.) - both in Texas; Pediatric Multiple Sclerosis Center at NYU Langone, New York (L.K.); Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Paris (M.T.); the Department of Neurology, University of California at San Francisco, San Francisco (E.W.); Novartis Pharmaceuticals, East Hanover, NJ (T.S., Y.C., N.P.); and Novartis Pharma, Basel, Switzerland (M.M.)
| | - Norman Putzki
- From the Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston (T.C.); Montreal Neurological Institute, McGill University, and NeuroRx Research - both in Montreal (D.L.A.); Children's Hospital of Philadelphia (B.B.) and the Center for Neuroinflammation and Experimental Neurotherapeutics and the Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania - all in Philadelphia; the Department of Neuropathology (W.B.) and the Department of Pediatrics and Adolescent Medicine, German Center for Multiple Sclerosis in Childhood and Adolescence (J.G.), University Medical Center Göttingen, Göttingen, and the Division of Pediatric Neurology, Children's Hospital Datteln, Witten/Herdecke University, Datteln (K.R.) - all in Germany; Gallarate Hospital, Gallarate, Italy (A.G.); Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London (G.G.); the University of Texas Southwestern Medical Center, Children's Health, Dallas (B.G.), and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.) - both in Texas; Pediatric Multiple Sclerosis Center at NYU Langone, New York (L.K.); Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Paris (M.T.); the Department of Neurology, University of California at San Francisco, San Francisco (E.W.); Novartis Pharmaceuticals, East Hanover, NJ (T.S., Y.C., N.P.); and Novartis Pharma, Basel, Switzerland (M.M.)
| | - Martin Merschhemke
- From the Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston (T.C.); Montreal Neurological Institute, McGill University, and NeuroRx Research - both in Montreal (D.L.A.); Children's Hospital of Philadelphia (B.B.) and the Center for Neuroinflammation and Experimental Neurotherapeutics and the Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania - all in Philadelphia; the Department of Neuropathology (W.B.) and the Department of Pediatrics and Adolescent Medicine, German Center for Multiple Sclerosis in Childhood and Adolescence (J.G.), University Medical Center Göttingen, Göttingen, and the Division of Pediatric Neurology, Children's Hospital Datteln, Witten/Herdecke University, Datteln (K.R.) - all in Germany; Gallarate Hospital, Gallarate, Italy (A.G.); Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London (G.G.); the University of Texas Southwestern Medical Center, Children's Health, Dallas (B.G.), and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.) - both in Texas; Pediatric Multiple Sclerosis Center at NYU Langone, New York (L.K.); Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Paris (M.T.); the Department of Neurology, University of California at San Francisco, San Francisco (E.W.); Novartis Pharmaceuticals, East Hanover, NJ (T.S., Y.C., N.P.); and Novartis Pharma, Basel, Switzerland (M.M.)
| | - Jutta Gärtner
- From the Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston (T.C.); Montreal Neurological Institute, McGill University, and NeuroRx Research - both in Montreal (D.L.A.); Children's Hospital of Philadelphia (B.B.) and the Center for Neuroinflammation and Experimental Neurotherapeutics and the Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania - all in Philadelphia; the Department of Neuropathology (W.B.) and the Department of Pediatrics and Adolescent Medicine, German Center for Multiple Sclerosis in Childhood and Adolescence (J.G.), University Medical Center Göttingen, Göttingen, and the Division of Pediatric Neurology, Children's Hospital Datteln, Witten/Herdecke University, Datteln (K.R.) - all in Germany; Gallarate Hospital, Gallarate, Italy (A.G.); Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London (G.G.); the University of Texas Southwestern Medical Center, Children's Health, Dallas (B.G.), and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.) - both in Texas; Pediatric Multiple Sclerosis Center at NYU Langone, New York (L.K.); Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Paris (M.T.); the Department of Neurology, University of California at San Francisco, San Francisco (E.W.); Novartis Pharmaceuticals, East Hanover, NJ (T.S., Y.C., N.P.); and Novartis Pharma, Basel, Switzerland (M.M.)
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Dale GH, Petersen T, Bacher Svendsen K, Christensen T, Houen G, Bek T. Time to steroid treatment in severe acute optic neuritis. Brain Behav 2018; 8:e01032. [PMID: 29931830 PMCID: PMC6085902 DOI: 10.1002/brb3.1032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 05/26/2018] [Accepted: 05/29/2018] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Steroid treatment can accelerate visual recovery in patients with optic neuritis (ON), but it is unknown whether the timing of the start of treatment influences the outcome. The main purpose of this observational study was to assess the effect of early onset steroid treatment of ON on visual prognosis and retinal morphology. METHODS Forty-nine patients with acute mild/moderate (n = 21) or severe (n = 28) ON, and an equal number of healthy controls were enrolled. Patients with severe ON either received early onset steroid treatment (initiated within 1 week of presentation with visual loss) (n = 9), late-onset treatment (initiated after 1 week) (n = 13), or no treatment (n = 6). Visual function and retinal morphology was studied after 6 and 12 months. RESULTS All measures of visual function had improved after 6 months (p ≤ 0.03) in the three groups with severe ON. This was not the case for Rayleigh match setting range (SR) in the nontreated group (p = 0.24), or for SR (p = 0.08) and latency to P100 of visual evoked potential (p = 0.08) in the late-onset treated group. After 12 months, further improvement occurred in the nontreated and late-treated groups, but not in the early treated group. Macular retinal nerve fiber layer (mRNFL) and ganglion cell plus inner plexiform layer had decreased significantly (p ≤ 0.001) in all three groups with severe ON after 6 months. After 12 months, only mRNFL had further significantly decreased and only in the late-onset treated group (p = 0.02). CONCLUSION The beneficial effects of early onset steroid treatment of ON is limited to a few months whereas the long-term prognosis is independent of the timing of treatment.
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Affiliation(s)
- Gro Helen Dale
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Thor Petersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Gunnar Houen
- Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen, Denmark
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
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Seasonal variations of 25-OH vitamin D serum levels are associated with clinical disease activity in multiple sclerosis patients. J Neurol Sci 2017; 375:160-164. [DOI: 10.1016/j.jns.2017.01.059] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 01/19/2017] [Accepted: 01/20/2017] [Indexed: 02/06/2023]
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Waldman A, Ness J, Pohl D, Simone IL, Anlar B, Amato MP, Ghezzi A. Pediatric multiple sclerosis: Clinical features and outcome. Neurology 2016; 87:S74-81. [PMID: 27572865 PMCID: PMC10688072 DOI: 10.1212/wnl.0000000000003028] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 07/01/2016] [Indexed: 11/15/2022] Open
Abstract
Multiple sclerosis (MS) in children manifests with a relapsing-remitting MS (RRMS) disease course. Acute relapses consist of new neurologic deficits persisting greater than 24 hours, in the absence of intercurrent illness, and occur with a higher frequency early in the disease as compared to adult-onset RRMS. Most pediatric patients with MS recover well from these early relapses, and cumulative physical disability is rare in the first 10 years of disease. Brainstem attacks, poor recovery from a single attack, and a higher frequency of attacks portend a greater likelihood of future disability. Although prospective pediatric-onset MS cohorts have been established in recent years, there remains very limited prospective data detailing the longer-term clinical outcome of pediatric-onset MS into adulthood. Whether the advent of MS therapies, and the largely off-label access to such therapies in pediatric MS, has improved prognosis is unknown. MS onset during the key formative academic years, concurrent with active cognitive maturation, is an important determinant of long-term outcome, and is discussed in detail in another article in this supplement. Finally, increasing recognition of pediatric MS worldwide, recent launch of phase III trials for new agents in the pediatric MS population, and the clear imperative to more fully appreciate health-related quality of life in pediatric MS through adulthood highlight the need for standardized, validated, and robust outcome measures.
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Affiliation(s)
- Amy Waldman
- From the Division of Neurology, Department of Pediatrics (A.W.), Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania; Department of Pediatrics (J.N.), University of Alabama at Birmingham and Children's of Alabama; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department of Basic Medical Sciences, Neurosciences and Sense Organs (I.L.S.), University of Bari, Italy; Department of Pediatric Neurology (B.A.), Hacettepe University, Ankara, Turkey; Department NEUROFARBA, Section Neurosciences (M.P.A.), University of Florence; and Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy.
| | - Jayne Ness
- From the Division of Neurology, Department of Pediatrics (A.W.), Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania; Department of Pediatrics (J.N.), University of Alabama at Birmingham and Children's of Alabama; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department of Basic Medical Sciences, Neurosciences and Sense Organs (I.L.S.), University of Bari, Italy; Department of Pediatric Neurology (B.A.), Hacettepe University, Ankara, Turkey; Department NEUROFARBA, Section Neurosciences (M.P.A.), University of Florence; and Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy
| | - Daniela Pohl
- From the Division of Neurology, Department of Pediatrics (A.W.), Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania; Department of Pediatrics (J.N.), University of Alabama at Birmingham and Children's of Alabama; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department of Basic Medical Sciences, Neurosciences and Sense Organs (I.L.S.), University of Bari, Italy; Department of Pediatric Neurology (B.A.), Hacettepe University, Ankara, Turkey; Department NEUROFARBA, Section Neurosciences (M.P.A.), University of Florence; and Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy
| | - Isabella Laura Simone
- From the Division of Neurology, Department of Pediatrics (A.W.), Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania; Department of Pediatrics (J.N.), University of Alabama at Birmingham and Children's of Alabama; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department of Basic Medical Sciences, Neurosciences and Sense Organs (I.L.S.), University of Bari, Italy; Department of Pediatric Neurology (B.A.), Hacettepe University, Ankara, Turkey; Department NEUROFARBA, Section Neurosciences (M.P.A.), University of Florence; and Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy
| | - Banu Anlar
- From the Division of Neurology, Department of Pediatrics (A.W.), Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania; Department of Pediatrics (J.N.), University of Alabama at Birmingham and Children's of Alabama; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department of Basic Medical Sciences, Neurosciences and Sense Organs (I.L.S.), University of Bari, Italy; Department of Pediatric Neurology (B.A.), Hacettepe University, Ankara, Turkey; Department NEUROFARBA, Section Neurosciences (M.P.A.), University of Florence; and Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy
| | - Maria Pia Amato
- From the Division of Neurology, Department of Pediatrics (A.W.), Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania; Department of Pediatrics (J.N.), University of Alabama at Birmingham and Children's of Alabama; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department of Basic Medical Sciences, Neurosciences and Sense Organs (I.L.S.), University of Bari, Italy; Department of Pediatric Neurology (B.A.), Hacettepe University, Ankara, Turkey; Department NEUROFARBA, Section Neurosciences (M.P.A.), University of Florence; and Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy
| | - Angelo Ghezzi
- From the Division of Neurology, Department of Pediatrics (A.W.), Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania; Department of Pediatrics (J.N.), University of Alabama at Birmingham and Children's of Alabama; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department of Basic Medical Sciences, Neurosciences and Sense Organs (I.L.S.), University of Bari, Italy; Department of Pediatric Neurology (B.A.), Hacettepe University, Ankara, Turkey; Department NEUROFARBA, Section Neurosciences (M.P.A.), University of Florence; and Divisione di Neurologia 2-Centro Studi Sclerosi Multipla (A.G.), Ospedale di Gallarate, Italy
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Yeh EA, Graves JS, Benson LA, Wassmer E, Waldman A. Pediatric optic neuritis. Neurology 2016; 87:S53-8. [PMID: 27572862 PMCID: PMC10688071 DOI: 10.1212/wnl.0000000000002822] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 01/12/2016] [Indexed: 11/15/2022] Open
Abstract
Optic neuritis (ON) is a common presenting symptom in pediatric CNS demyelinating disorders and may be associated with dramatic visual loss. Knowledge regarding clinical presentation, associated diseases, therapy, and outcomes in ON in children has grown over the past decade. These studies have shown that younger children (<10 years of age) are more likely to present with bilateral ON and older children with unilateral ON. Furthermore, studies focusing on visual recovery have shown excellent recovery of high-contrast visual acuity in the majority of children, but functional and structural studies have shown evidence of irreversible injury and functional decline after ON in children. Although randomized controlled treatment trials have not been performed in children and adolescents with ON, standard of care suggests that the use of high-dose pulse steroids is safe and likely effective. This article reviews current knowledge about the clinical presentation and management of pediatric ON, with attention to associated syndromes and evaluative tools that may inform diagnosis and interventions.
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Affiliation(s)
- E Ann Yeh
- From the Division of Neurology (E.A.Y.), Hospital for Sick Children, Hospital for Sick Children Research Institute, Department of Pediatrics, University of Toronto, Ontario, Canada; Department of Neurology (J.S.G.), University of California, San Francisco; Department of Neurology (L.A.B.), Boston Children's Hospital, Boston, MA; Department of Neurology (E.W.), Birmingham Children's Hospital, Birmingham, UK; and Department of Neurology (A.W.), The Children's Hospital of Philadelphia, PA.
| | - Jennifer S Graves
- From the Division of Neurology (E.A.Y.), Hospital for Sick Children, Hospital for Sick Children Research Institute, Department of Pediatrics, University of Toronto, Ontario, Canada; Department of Neurology (J.S.G.), University of California, San Francisco; Department of Neurology (L.A.B.), Boston Children's Hospital, Boston, MA; Department of Neurology (E.W.), Birmingham Children's Hospital, Birmingham, UK; and Department of Neurology (A.W.), The Children's Hospital of Philadelphia, PA
| | - Leslie A Benson
- From the Division of Neurology (E.A.Y.), Hospital for Sick Children, Hospital for Sick Children Research Institute, Department of Pediatrics, University of Toronto, Ontario, Canada; Department of Neurology (J.S.G.), University of California, San Francisco; Department of Neurology (L.A.B.), Boston Children's Hospital, Boston, MA; Department of Neurology (E.W.), Birmingham Children's Hospital, Birmingham, UK; and Department of Neurology (A.W.), The Children's Hospital of Philadelphia, PA
| | - Evangeline Wassmer
- From the Division of Neurology (E.A.Y.), Hospital for Sick Children, Hospital for Sick Children Research Institute, Department of Pediatrics, University of Toronto, Ontario, Canada; Department of Neurology (J.S.G.), University of California, San Francisco; Department of Neurology (L.A.B.), Boston Children's Hospital, Boston, MA; Department of Neurology (E.W.), Birmingham Children's Hospital, Birmingham, UK; and Department of Neurology (A.W.), The Children's Hospital of Philadelphia, PA
| | - Amy Waldman
- From the Division of Neurology (E.A.Y.), Hospital for Sick Children, Hospital for Sick Children Research Institute, Department of Pediatrics, University of Toronto, Ontario, Canada; Department of Neurology (J.S.G.), University of California, San Francisco; Department of Neurology (L.A.B.), Boston Children's Hospital, Boston, MA; Department of Neurology (E.W.), Birmingham Children's Hospital, Birmingham, UK; and Department of Neurology (A.W.), The Children's Hospital of Philadelphia, PA
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Binocular low-contrast letter acuity and the symbol digit modalities test improve the ability of the Multiple Sclerosis Functional Composite to predict disease in pediatric multiple sclerosis. Mult Scler Relat Disord 2016; 10:73-78. [PMID: 27919503 DOI: 10.1016/j.msard.2016.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/24/2016] [Accepted: 08/25/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Outcome measures to capture disability, such as the Multiple Sclerosis Functional Composite (MSFC), were developed to enhance outcome measurements for clinical trials in adults with multiple sclerosis (MS). The MSFC initially included three components: a timed 25-foot walk [T25FW], 9-hole peg test [9HPT], and the Paced Auditory Serial Addition Task [PASAT]. Modifications to the original MSFC, such as adding binocular low-contrast letter acuity (LCLA) or substituting the symbol digit modalities test (SDMT) for the PASAT, improved the capacity to capture neurologic impairment in adults. Similar outcome scales for pediatric MS have not yet been established. OBJECTIVE To determine whether the three-component MSFC or a modified MSFC with LCLA and the SDMT better identifies neurological deficits in pediatric MS. METHODS We evaluated 5 measures (T25FW, 9HPT, Children's PASAT [ChiPASAT], SDMT, and binocular LCLA [Sloan charts, 1.25% contrast]) in children with MS (disease onset <18 years) and healthy controls. To be able to compare measures whose scores have different scales, Z-scores were also created for each test based on the numbers of standard deviations from a control group mean, and these individual scale scores were combined to create composite scores. Logistic regression models, accounting for age, were used to determine whether the standard 3-component MSFC or modified versions (including 4 or 5 metrics) best distinguished children with MS from controls. RESULTS Twenty pediatric-onset MS subjects, aged 6-21 years, and thirteen healthy controls, aged 6-19 years, were enrolled. MS subjects demonstrated worse scores on the 9HPT (p=0.004) and SDMT (p=0.001), but not the 25FTW (adjusted for height, p=0.63) or the ChiPASAT (p=0.10): all comparisons adjusted for age. Decreased (worse) binocular LCLA scores were associated with MS (vs. control status, p=0.03, logistic regression; p=0.08, accounting for age). The MSFC composite score for the traditional 3 components did not differ between the groups (p=0.28). Replacing the ChiPASAT with the SDMT (OR 0.72, p=0.05) better distinguished MS from controls. A modified MSFC-4 with the SDMT replacing the ChiPASAT and including binocular 1.25% LCLA had the greatest capacity to distinguish pediatric MS from controls (OR 0.89, p=0.04, logistic regression). Including all 5 metrics as a composite MSFC-5 did not improve the model (p=0.18). CONCLUSIONS A modified MSFC (25FTW, 9HPT, SMDT, and binocular 1.25% LCLA) is more sensitive than the traditional MSFC or its components to capture the subtle impairments that characterize pediatric MS and should be validated in order to be considered for future pediatric MS trials.
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Burton JM, Eliasziw M, Trufyn J, Tung C, Carter G, Costello F. A prospective cohort study of vitamin D in optic neuritis recovery. Mult Scler 2016; 23:82-93. [PMID: 27037181 DOI: 10.1177/1352458516642315] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: Vitamin D sufficiency is associated with better inflammatory outcomes in multiple sclerosis (MS). We hypothesize that it is also associated with better long-term neurodegenerative measures. Objectives: To show that vitamin D sufficient patients (25-hydroxy vitamin D (25(OH)D) > 80 nmol/L) have better optical coherence tomography (OCT) neuroaxonal measures of ganglion cell layer (GCL) and retinal nerve fiber layer (RNFL) thickness after optic neuritis. Methods: In this prospective cohort study, acute optic neuritis patients underwent OCT and serum 25(OH)D assessments at baseline and at month 6, with comparisons between vitamin D sufficient and insufficient patients, and men and women. Potential confounding variables were evaluated. Results: Of 49 enrolled, 36 had complete, analyzable data. At baseline, vitamin D insufficiency was associated with greater RNFL thickness (134.3 vs. 95.2 µm; p = 0.003) in affected eyes. At month 6, insufficient patients had greater GCL thinning (GCL inter-eye difference: 14.2 vs. 4.0 µm, p = 0.008). Men had greater RNFL and GCL thinning than women (GCL: 61.2 vs. 69.6 µm, p = 0.036). Conclusion: Acutely, in optic neuritis, RNFL thickness is increased with vitamin D insufficiency. Chronically, neuronal, and possibly axonal loss are associated with vitamin D insufficiency and male gender, suggesting vitamin D and female gender may confer neuroprotection in optic neuritis, and possibly, central nervous system (CNS) inflammatory disease.
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Affiliation(s)
- Jodie M Burton
- Department of Clinical Neurosciences and Department of Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Misha Eliasziw
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Jessie Trufyn
- Neurosciences Graduate Program, University of Calgary, Calgary, AB, Canada
| | - Chelsia Tung
- Biological Sciences Undergraduate Sciences Program, University of Calgary, Calgary, AB, Canada
| | - Gorden Carter
- Eye Clinic, Rockyview General Hospital, Calgary, AB, Canada
| | - Fiona Costello
- Department of Clinical Neurosciences and Department of Surgery (Ophthalmology), Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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29
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Recovery from optic neuritis attack in neuromyelitis optica spectrum disorder and multiple sclerosis. J Neurol Sci 2016; 367:375-9. [PMID: 27423624 DOI: 10.1016/j.jns.2016.06.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 06/15/2016] [Accepted: 06/16/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Both neuromyelitis optica spectrum disorder (NMOsd) and multiple sclerosis (MS) patients experience optic neuritis (ON) attacks characterized by rapidly reduced best-correct visual acuity (BCVA) and slow recovery. Prognosis and effects of recurrence on recovery may differ between disorders but remain unclear. OBJECTIVE To compare ON severity, time and degree of recovery and effects of previous ON between NMOsd and MS patients. METHODS Retrospective chart review was performed. BCVA measurements acquired before ON, at nadir and during recovery were retrospectively reviewed. Records were obtained on 69 ON attacks in 36 NMOsd patients and 43 attacks in 28 MS patients, including first episodes and recurrences. RESULTS NMOsd patients exhibited significantly lower BCVA values at all time points after attack (P<0.05), reached nadir earlier (P=0.014) and regained a smaller fraction of baseline BCVA than MS patients (P<0.001). In NMOsd, relapsed ON resulted in worse recovery and tended to reach nadir earlier than first-episode ON (P=0.030 and 0.059, respectively). In MS, relapsed ON also reached nadir earlier (P=0.042); however, there was no difference in recovery. CONCLUSIONS Recovery from ON was poorer in NMOsd than in MS and was negatively affected by previous ON attacks.
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30
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Some recent advances in multiple sclerosis. J Neurol 2016; 263:1880-6. [DOI: 10.1007/s00415-016-8124-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 01/22/2023]
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Becker J, Callegaro D, Lana-Peixoto MA, Talim N, Vidaletti T, de Paula Corrêa M, Gomes I. Hypovitaminosis D association with disease activity in relapsing remitting multiple sclerosis in Brazil. J Neurol Sci 2016; 363:236-9. [DOI: 10.1016/j.jns.2016.02.064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/06/2016] [Accepted: 02/26/2016] [Indexed: 01/27/2023]
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Tur C, Goodkin O, Altmann DR, Jenkins TM, Miszkiel K, Mirigliani A, Fini C, Gandini Wheeler-Kingshott CAM, Thompson AJ, Ciccarelli O, Toosy AT. Longitudinal evidence for anterograde trans-synaptic degeneration after optic neuritis. Brain 2016; 139:816-28. [PMID: 26912640 DOI: 10.1093/brain/awv396] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 11/18/2015] [Indexed: 11/14/2022] Open
Abstract
In multiple sclerosis, microstructural damage of normal-appearing brain tissue is an important feature of its pathology. Understanding these mechanisms is vital to help develop neuroprotective strategies. The visual pathway is a key model to study mechanisms of damage and recovery in demyelination. Anterograde trans-synaptic degeneration across the lateral geniculate nuclei has been suggested as a mechanism of tissue damage to explain optic radiation abnormalities seen in association with demyelinating disease and optic neuritis, although evidence for this has relied solely on cross-sectional studies. We therefore aimed to assess: (i) longitudinal changes in the diffusion properties of optic radiations after optic neuritis suggesting trans-synaptic degeneration; (ii) the predictive value of early optic nerve magnetic resonance imaging measures for late optic radiations changes; and (iii) the impact on visual outcome of both optic nerve and brain post-optic neuritis changes. Twenty-eight consecutive patients with acute optic neuritis and eight healthy controls were assessed visually (logMAR, colour vision, and Sloan 1.25%, 5%, 25%) and by magnetic resonance imaging, at baseline, 3, 6, and 12 months. Magnetic resonance imaging sequences performed (and metrics obtained) were: (i) optic nerve fluid-attenuated inversion-recovery (optic nerve cross-sectional area); (ii) optic nerve proton density fast spin-echo (optic nerve proton density-lesion length); (iii) optic nerve post-gadolinium T1-weighted (Gd-enhanced lesion length); and (iv) brain diffusion-weighted imaging (to derive optic radiation fractional anisotropy, radial diffusivity, and axial diffusivity). Mixed-effects and multivariate regression models were performed, adjusting for age, gender, and optic radiation lesion load. These identified changes over time and associations between early optic nerve measures and 1-year global optic radiation/clinical measures. The fractional anisotropy in patients' optic radiations decreased (P = 0.018) and radial diffusivity increased (P = 0.002) over 1 year following optic neuritis, whereas optic radiation measures were unchanged in controls. Also, smaller cross-sectional areas of affected optic nerves at 3 months post-optic neuritis predicted lower fractional anisotropy and higher radial diffusivity at 1 year (P = 0.007) in the optic radiations, whereas none of the inflammatory measures of the optic nerve predicted changes in optic radiations. Finally, greater Gd-enhanced lesion length at baseline and greater optic nerve proton density-lesion length at 1 year were associated with worse visual function at 1 year (P = 0.034 for both). Neither the cross-sectional area of the affected optic nerve after optic neuritis nor the damage in optic radiations was associated with 1-year visual outcome. Our longitudinal study shows that, after optic neuritis, there is progressive damage to the optic radiations, greater in patients with early residual optic nerve atrophy, even after adjusting for optic radiation lesions. These findings provide evidence for trans-synaptic degeneration.
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Affiliation(s)
- Carmen Tur
- 1 Queen Square Multiple Sclerosis Centre, University College London, UCL Institute of Neurology, London, UK
| | - Olivia Goodkin
- 1 Queen Square Multiple Sclerosis Centre, University College London, UCL Institute of Neurology, London, UK
| | - Daniel R Altmann
- 1 Queen Square Multiple Sclerosis Centre, University College London, UCL Institute of Neurology, London, UK 2 Medical Statistics Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Thomas M Jenkins
- 1 Queen Square Multiple Sclerosis Centre, University College London, UCL Institute of Neurology, London, UK
| | - Katherine Miszkiel
- 1 Queen Square Multiple Sclerosis Centre, University College London, UCL Institute of Neurology, London, UK
| | - Alessia Mirigliani
- 1 Queen Square Multiple Sclerosis Centre, University College London, UCL Institute of Neurology, London, UK
| | - Camilla Fini
- 1 Queen Square Multiple Sclerosis Centre, University College London, UCL Institute of Neurology, London, UK
| | - Claudia A M Gandini Wheeler-Kingshott
- 1 Queen Square Multiple Sclerosis Centre, University College London, UCL Institute of Neurology, London, UK 3 Brain Connectivity Center, C. Mondino National Neurological Institute, Pavia, Italy
| | - Alan J Thompson
- 1 Queen Square Multiple Sclerosis Centre, University College London, UCL Institute of Neurology, London, UK
| | - Olga Ciccarelli
- 1 Queen Square Multiple Sclerosis Centre, University College London, UCL Institute of Neurology, London, UK
| | - Ahmed T Toosy
- 1 Queen Square Multiple Sclerosis Centre, University College London, UCL Institute of Neurology, London, UK
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Lochner P, Leone MA, Coppo L, Nardone R, Zedde ML, Cantello R, Brigo F. B-mode transorbital ultrasononography for the diagnosis of acute optic neuritis. A systematic review. Clin Neurophysiol 2016; 127:803-809. [DOI: 10.1016/j.clinph.2015.05.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 04/25/2015] [Accepted: 05/02/2015] [Indexed: 11/16/2022]
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Golnik KC. Neuro-Ophthalmology Annual Review. Asia Pac J Ophthalmol (Phila) 2015; 4:307-15. [PMID: 26417928 DOI: 10.1097/apo.0000000000000147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The purpose of this review was to update the practicing ophthalmologist on the English language neuro-ophthalmology literature from the past year. DESIGN A review of English language literature from August 1, 2013, to August 1, 2014, was conducted. METHODS The author searched PubMed from August 1, 2013, to August 1, 2014, limited to English language publications including original articles, review articles, and case reports and excluding letters to the editor, unpublished work, and abstracts. The following topics were searched: pupillary abnormalities, eye movement dysfunction, neuromuscular diseases, optic neuropathies, optic neuritis, demyelinating diseases including multiple sclerosis, lesions of the optic chiasm and posterior primary visual pathways, elevated intracranial pressure, tumors and aneurysms affecting the visual pathways, vascular diseases, higher visual function, and neuroimaging advances. The focus of this review is on clinically relevant literature in the past year for the practicing ophthalmologist. The aim was to highlight remarkable and interesting literature rather than exhaustively including all new neuro-ophthalmological publications of the year. RESULTS Initially, more than 11,000 articles were identified. One hundred were selected that met criteria specified above. CONCLUSIONS This review updates the comprehensive ophthalmologist on neuro-ophthalmic topics.
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Affiliation(s)
- Karl C Golnik
- From the Department of Ophthalmology, University of Cincinnati and the Cincinnati Eye Institute, Cincinnati, OH
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35
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Mealy MA, Whetstone A, Orman G, Izbudak I, Calabresi PA, Levy M. Longitudinally extensive optic neuritis as an MRI biomarker distinguishes neuromyelitis optica from multiple sclerosis. J Neurol Sci 2015; 355:59-63. [PMID: 26026942 PMCID: PMC4492883 DOI: 10.1016/j.jns.2015.05.013] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 04/29/2015] [Accepted: 05/11/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To differentiate MRI characteristics of optic neuritis associated with neuromyelitis optica (NMO) and relapsing remitting multiple sclerosis (RRMS). BACKGROUND Optic neuritis is a common presenting feature of both neuromyelitis optica and multiple sclerosis. Distinguishing between NMO and RRMS is important in guiding treatment, but biomarkers of NMO and MS can be absent early in the disease process. We looked for differences in MRI characteristics of optic neuritis associated with NMO and MS that provide an early clue in the diagnostic workup. DESIGN/METHODS We conducted a retrospective analysis of 26 NMO and 26 RRMS patients presenting to the Johns Hopkins Hospital with MRI-confirmed acute optic neuritis. MRIs were assessed to identify the location and longitudinal extent of each contrast enhancing lesion. For the purposes of this study, the optic nerve was divided into intraorbital, canalicular, pre-chiasmal, chiasmal, and optic tract. RESULTS There are distinct differences in MRI characteristics between NMO- and RRMS-associated optic neuritis. The majority of NMO lesions were longitudinally extensive measuring at least 17.6mm in length and involving at least three optic nerve segments. At a cutoff of 17.6mm lesion length, the specificity for NMO is 76.9% with a sensitivity of 80.8% and positive likelihood ratio of 3.50. Conversely, MS lesions were more commonly focal in one optic nerve segment localized anteriorly. CONCLUSIONS Optic neuritis in NMO has a distinct pattern on MRI as compared with RRMS and can help differentiate these two neuroinflammatory diseases at presentation.
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Affiliation(s)
- Maureen A Mealy
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Anna Whetstone
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Gunes Orman
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Izlem Izbudak
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Levy
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
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Galetta SL, Villoslada P, Levin N, Shindler K, Ishikawa H, Parr E, Cadavid D, Balcer LJ. Acute optic neuritis: Unmet clinical needs and model for new therapies. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2015; 2:e135. [PMID: 26236761 PMCID: PMC4516397 DOI: 10.1212/nxi.0000000000000135] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/13/2015] [Indexed: 01/22/2023]
Abstract
Idiopathic demyelinating optic neuritis (ON) most commonly presents as acute unilateral vision loss and eye pain and is frequently associated with multiple sclerosis. Although emphasis is often placed on the good recovery of high-contrast visual acuity, persistent deficits are frequently observed in other aspects of vision, including contrast sensitivity, visual field testing, color vision, motion perception, and vision-related quality of life. Persistent and profound structural and functional changes are often revealed by imaging and electrophysiologic techniques, including optical coherence tomography, visual-evoked potentials, and nonconventional MRI. These abnormalities can impair patients' abilities to perform daily activities (e.g., driving, working) so they have important implications for patients' quality of life. In this article, we review the sequelae from ON, including clinical, structural, and functional changes and their interrelationships. The unmet needs in each of these areas are considered and the progress made toward meeting those needs is examined. Finally, we provide an overview of past and present investigational approaches for disease modification in ON.
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Affiliation(s)
- Steven L Galetta
- Departments of Neurology (S.L.G., L.J.B.), Ophthalmology (S.L.G., L.J.B.), and Population Health (L.J.B.), New York University School of Medicine, New York, NY; Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clinic of Barcelona (P.V.), Barcelona, Spain; Department of Neurology (P.V.), University of California, San Francisco; Department of Neurology (N.L.), The Agnes Ginges Center for Human Neurogenetics, Hadassah Hebrew-University Medical Center, Jerusalem, Israel; Scheie Eye Institute and FM Kirby Center for Molecular Ophthalmology (K.S.), University of Pennsylvania, Philadelphia; UPMC Eye Center (H.I.), Eye and Ear Institute, Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, PA; Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA; Excel Scientific Solutions (E.P.), Southport, CT; and Biogen (D.C.), Cambridge, MA
| | - Pablo Villoslada
- Departments of Neurology (S.L.G., L.J.B.), Ophthalmology (S.L.G., L.J.B.), and Population Health (L.J.B.), New York University School of Medicine, New York, NY; Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clinic of Barcelona (P.V.), Barcelona, Spain; Department of Neurology (P.V.), University of California, San Francisco; Department of Neurology (N.L.), The Agnes Ginges Center for Human Neurogenetics, Hadassah Hebrew-University Medical Center, Jerusalem, Israel; Scheie Eye Institute and FM Kirby Center for Molecular Ophthalmology (K.S.), University of Pennsylvania, Philadelphia; UPMC Eye Center (H.I.), Eye and Ear Institute, Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, PA; Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA; Excel Scientific Solutions (E.P.), Southport, CT; and Biogen (D.C.), Cambridge, MA
| | - Netta Levin
- Departments of Neurology (S.L.G., L.J.B.), Ophthalmology (S.L.G., L.J.B.), and Population Health (L.J.B.), New York University School of Medicine, New York, NY; Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clinic of Barcelona (P.V.), Barcelona, Spain; Department of Neurology (P.V.), University of California, San Francisco; Department of Neurology (N.L.), The Agnes Ginges Center for Human Neurogenetics, Hadassah Hebrew-University Medical Center, Jerusalem, Israel; Scheie Eye Institute and FM Kirby Center for Molecular Ophthalmology (K.S.), University of Pennsylvania, Philadelphia; UPMC Eye Center (H.I.), Eye and Ear Institute, Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, PA; Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA; Excel Scientific Solutions (E.P.), Southport, CT; and Biogen (D.C.), Cambridge, MA
| | - Kenneth Shindler
- Departments of Neurology (S.L.G., L.J.B.), Ophthalmology (S.L.G., L.J.B.), and Population Health (L.J.B.), New York University School of Medicine, New York, NY; Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clinic of Barcelona (P.V.), Barcelona, Spain; Department of Neurology (P.V.), University of California, San Francisco; Department of Neurology (N.L.), The Agnes Ginges Center for Human Neurogenetics, Hadassah Hebrew-University Medical Center, Jerusalem, Israel; Scheie Eye Institute and FM Kirby Center for Molecular Ophthalmology (K.S.), University of Pennsylvania, Philadelphia; UPMC Eye Center (H.I.), Eye and Ear Institute, Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, PA; Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA; Excel Scientific Solutions (E.P.), Southport, CT; and Biogen (D.C.), Cambridge, MA
| | - Hiroshi Ishikawa
- Departments of Neurology (S.L.G., L.J.B.), Ophthalmology (S.L.G., L.J.B.), and Population Health (L.J.B.), New York University School of Medicine, New York, NY; Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clinic of Barcelona (P.V.), Barcelona, Spain; Department of Neurology (P.V.), University of California, San Francisco; Department of Neurology (N.L.), The Agnes Ginges Center for Human Neurogenetics, Hadassah Hebrew-University Medical Center, Jerusalem, Israel; Scheie Eye Institute and FM Kirby Center for Molecular Ophthalmology (K.S.), University of Pennsylvania, Philadelphia; UPMC Eye Center (H.I.), Eye and Ear Institute, Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, PA; Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA; Excel Scientific Solutions (E.P.), Southport, CT; and Biogen (D.C.), Cambridge, MA
| | - Edward Parr
- Departments of Neurology (S.L.G., L.J.B.), Ophthalmology (S.L.G., L.J.B.), and Population Health (L.J.B.), New York University School of Medicine, New York, NY; Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clinic of Barcelona (P.V.), Barcelona, Spain; Department of Neurology (P.V.), University of California, San Francisco; Department of Neurology (N.L.), The Agnes Ginges Center for Human Neurogenetics, Hadassah Hebrew-University Medical Center, Jerusalem, Israel; Scheie Eye Institute and FM Kirby Center for Molecular Ophthalmology (K.S.), University of Pennsylvania, Philadelphia; UPMC Eye Center (H.I.), Eye and Ear Institute, Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, PA; Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA; Excel Scientific Solutions (E.P.), Southport, CT; and Biogen (D.C.), Cambridge, MA
| | - Diego Cadavid
- Departments of Neurology (S.L.G., L.J.B.), Ophthalmology (S.L.G., L.J.B.), and Population Health (L.J.B.), New York University School of Medicine, New York, NY; Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clinic of Barcelona (P.V.), Barcelona, Spain; Department of Neurology (P.V.), University of California, San Francisco; Department of Neurology (N.L.), The Agnes Ginges Center for Human Neurogenetics, Hadassah Hebrew-University Medical Center, Jerusalem, Israel; Scheie Eye Institute and FM Kirby Center for Molecular Ophthalmology (K.S.), University of Pennsylvania, Philadelphia; UPMC Eye Center (H.I.), Eye and Ear Institute, Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, PA; Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA; Excel Scientific Solutions (E.P.), Southport, CT; and Biogen (D.C.), Cambridge, MA
| | - Laura J Balcer
- Departments of Neurology (S.L.G., L.J.B.), Ophthalmology (S.L.G., L.J.B.), and Population Health (L.J.B.), New York University School of Medicine, New York, NY; Center of Neuroimmunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clinic of Barcelona (P.V.), Barcelona, Spain; Department of Neurology (P.V.), University of California, San Francisco; Department of Neurology (N.L.), The Agnes Ginges Center for Human Neurogenetics, Hadassah Hebrew-University Medical Center, Jerusalem, Israel; Scheie Eye Institute and FM Kirby Center for Molecular Ophthalmology (K.S.), University of Pennsylvania, Philadelphia; UPMC Eye Center (H.I.), Eye and Ear Institute, Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, PA; Department of Bioengineering (H.I.), Swanson School of Engineering, University of Pittsburgh, PA; Excel Scientific Solutions (E.P.), Southport, CT; and Biogen (D.C.), Cambridge, MA
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Demographic Analysis of Patients With Multiple Sclerosis; Individual Variability Related to the Time Interval. ARCHIVES OF NEUROSCIENCE 2015. [DOI: 10.5812/archneurosci.21806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vitamin D in Multiple Sclerosis and Central Nervous System Demyelinating Disease—A Review. J Neuroophthalmol 2015; 35:194-200. [DOI: 10.1097/wno.0000000000000256] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pihl-Jensen G, Frederiksen JL. 25-Hydroxyvitamin D levels in acute monosymptomatic optic neuritis: relation to clinical severity, paraclinical findings and risk of multiple sclerosis. J Neurol 2015; 262:1646-54. [PMID: 25929657 DOI: 10.1007/s00415-015-7740-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 04/02/2015] [Accepted: 04/03/2015] [Indexed: 12/30/2022]
Abstract
Optic neuritis (ON) is a common first symptom of MS and only few studies have thus far investigated vitamin D at this early stage of MS. The objectives of the study were to examine total 25-hydroxyvitamin D levels (25HVITDL) in patients in acute (A) ON and to determine whether 25HVITD levels in AON (1) predict risk of RRMS and (2) are associated with visual tests of ON severity. A cross-sectional study was conducted of mean 25HVITDL differences between ON (n = 164) and MS (n = 948) patients and of prevalence of 25HVITDL deficiency (<50 nmol/L) in ON and MS (two-sample t test, χ (2) test). Associations between 25HVITDL and (1) clinical ON severity, (2) paraclinical findings suggestive of MS [logistic regression (LRA), Spearman correlation] and (3) hazard of MS development [Cox (C) RA] in ON patients were assessed. 25HVITDL were deseasonalized before analysis. The mean levels were 47.6 (ON) and 63.9 (MS) nmol/L (p < 0.0001), and a significantly higher prevalence of 25HVITD deficiency in ON (56 %; 35 %) (p < 0.0001), most pronounced in females, was shown. Associations were found between 25HVITDL and both CSF leukocyte count (ρ = -0.177, p = 0.028) and IgG index elevation (OR 0.980, p = 0.031). Forty-one ON patients developed MS during the study. Multivariate CRA showed no effect on hazard of MS (HR: 0.991, p 0.284). No association was found between 25HVITDL and visual tests (acuity, contrast vision) or OCT RNFL or GCL thickness. The study indicates a high prevalence of 25HVITD deficiency in AON. 25HVITDL was significantly associated with CSF leukocyte count, but not ON severity. The study indicates a possible role of vitamin D in the early stages of MS, but does not support the use of 25HVITDL as a predictor of MS development in acute ON.
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Affiliation(s)
- Gorm Pihl-Jensen
- Clinic of Optic Neuritis, Department of Neurology, Glostrup Hospital, University of Copenhagen, Nordre Ringvej 57, 2600, Glostrup, Denmark,
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